Extract:
A 12‐year‐old boy was admitted to the critical care unit with traumatic brain injury and a mid‐shaft femoral fracture following a fall from height, and was scheduled for internal fixation of the femur. Pre‐operatively, a member of the critical care team inserted a central venous catheter under ultrasound guidance into what they thought was the right internal jugular vein. However, when the central venous catheter was used for the induction of general anaesthesia, the patient did not lose consciousness as expected, but developed bradycardia followed by asystole. After 5 minutes of cardiopulmonary resuscitation, return of spontaneous circulation was achieved. The central venous catheter was not used again; a peripheral cannula was instead used for intra‐operative drug and fluid administration. Postoperatively, bedside echocardiography demonstrated a pericardial effusion. Computed tomography scanning of the thorax was then performed, with a small dose of contrast injected via the central venous catheter, which was seen to course through the mediastinum with its tip lying inside the pericardial sac (Fig. 1). No part of the central venous catheter traversed any vascular structure.
Reference:
Elayavel R, Bandyopadhyay A, Dwivedi A, Bhatia N, Puri S, Jain K. Accidental insertion of a central venous catheter into the pericardial sac without traversing vascular structures. Anaesth Rep. 2020 Dec 13;8(2):201-202. doi: 10.1002/anr3.12089. PMID: 33345193; PMCID: PMC7734421.