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