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Inadvertent arterial insertion of a central venous catheter: delayed recognition with abrupt changes in pressure waveform during surgery -A case report-.

Authors
 Yong Seon Choi ; Ji Young Park ; Jong Wha Lee ; Young Lan Kwak 
Citation
 Korean Journal of Anesthesiology, Vol.60(1) : 47~51, 2011 
Journal Title
 Korean Journal of Anesthesiology 
ISSN
 2005-6419 
Issue Date
2011
Abstract
We present a case of inadvertent arterial insertion of a central venous catheter, identified during a pericardiectomy procedure after observing abrupt changes in pressure waveform and confirmed via arterial blood gas analysis and transesophageal echocardiography. Central venous pressure measurement was initially 20 mmHg in supine, and then elevated to 30-40 mmHg in right lateral decubitus, presumably resulting from constrictive physiology of pericarditis. The pressure waveforms, however, abruptly changed from a venous to an arterial waveform during surgery. When visual discrimination between arterial and venous blood regurgitation is unreliable, anesthesiologists should confirm that using all the available methods one has on the scene, especially after at least two unsuccessful attempts or in patients with advanced age or clinical conditions resulting in jugular venous dilation. To prevent arterial catheterization, one should limit the leftward rotation of the head by <40° and consider using ultrasound-guided method after more than two unsuccessful attempts.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/92977
DOI
10.4097/kjae.2011.60.1.47
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Anesthesiology and Pain Medicine
Yonsei Authors
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