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"This demonstrated a stenosed left brachiocephalic vein lumen, almost completely occluded by the CVC" Barker et al (2021).
CVC insertion and impact of mediastinal radiotherapy


“A 79-y-old man was admitted to the High Dependency Unit (HDU) following elective open hemicolectomy. The procedure was prolonged by the need for extensive adhesiolysis. Vascular access consisted of 20G and 16G cannulae in the veins of the right arm, and a 20G cannula in the left radial artery. Intra-operatively, an 8.5fr quad-lumen central venous catheter (CVC) was inserted into his left internal jugular vein for vasopressor support. Its ports were aspirated and flushed, and position was confirmed on chest radiograph (CXR) postoperatively. Though the right internal jugular vein is the favoured site of CVC insertion because the left has a more tortuous route [1], the proximity of the anaesthetic machine and other surgical equipment to the patient’s right side meant that the clinician felt left sided insertion was more appropriate.”

“On the first postoperative day, the arterial line was removed, and the maintenance fluid infusion was disconnected from the CVC before HDU discharge. Over the next hour, the patient developed left arm swelling, skin mottling and worsening pain. The limb remained intact neurologically with arterial pulses present. Bedside ultrasound imaging demonstrated distended, non-compressible, brachial and cephalic veins. A vascular surgeon was asked to review the patient and recommended urgent computed tomography (CT) angiography to exclude vascular injury. This demonstrated a stenosed left brachiocephalic vein lumen, almost completely occluded by the CVC (Fig. 1; Supplemental Video S1). Symptoms rapidly resolved following CVC removal.”


Barker OJH, Patton CV, Doherty WL. Mediastinal radiotherapy and central vein catheters: a warning. Anaesth Rep. 2021 Oct 7;9(2):e12131. doi: 10.1002/anr3.12131. PMID: 34651128; PMCID: PMC8496158.