Central venous catheter insertion and brachiocephalic vein perforation

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We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion” Winkes et al (2016).

Abstract:

Purpose: We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion.

Method and results: An 80-year-old patient underwent an ultrasound-guided hemodialysis (HD) catheter placement via his left internal jugular vein (IJV). One day postoperatively, the patient became hemodynamically unstable immediately after HD initiation. As a vascular event was feared, an emergency CT scan was performed demonstrating a BCV perforation. The patient underwent a sternotomy, the lines were removed and the venous laceration was closed. The patient recovered well.

Conclusions: In spite of ultrasound guidance, fluoroscopy for guidewire and sheath advancement, venous blood aspiration and a normal appearing postoperative x-ray, traumatic central venous catheter placement is still possible. Tenting of the BCV wall during catheter advancement possibly caused the venous perforation. A ‘how-to’ for correct catheter placement via the IJV is provided and potential pitfalls during each procedural step are discussed.

Reference:

Winkes, M.B., Loos, M.J., Scheltinga, M.R. and Teijink, J.A. (2016) Dialysis catheter placement via the left internal jugular vein: risk of brachiocephalic vein perforation
The Journal of Vascular Access. 17(4), p. 293 – 372, e65 – e141.

DOI:10.5301/jva.5000566.

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