Hemodialysis catheter insertion: is increased PO2 a sign of arterial cannulation? A case report

BMC Nephrology

Aylin R Rodan¹  Jiten Patel¹  Javier A Neyra¹  Julio C Chirinos¹ 

[1] Department of Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas, USA

关键词: Vein anomaly;    Central venous cannulation;    Catheter;    Hemodialysis;   

Others  :  1082646
DOI  :  10.1186/1471-2369-15-127

 received in 2014-03-15, accepted in 2014-07-22,  发布年份 2014

【 摘 要 】

Background

Ultrasound-guided Central Venous Catheterization (CVC) for temporary vascular access, preferably using the right internal jugular vein, is widely accepted by nephrologists. However CVC is associated with numerous potential complications, including death. We describe the finding of a rare left-sided partial anomalous pulmonary vein connection during central venous catheterization for continuous renal replacement therapy (CRRT).

Case presentation

Ultrasound-guided cannulation of a large bore temporary dual-lumen Quinton-Mahurkar catheter into the left internal jugular vein was performed for CRRT initiation in a 66 year old African-American with sepsis-related oliguric acute kidney injury. The post-procedure chest X-ray suggested inadvertent left carotid artery cannulation. Blood gases obtained from the catheter showed high partial pressure of oxygen (PO₂) of 140 mmHg and low partial pressure of carbon dioxide (PCO₂) of 22 mmHg, suggestive of arterial cannulation. However, the pressure-transduced wave forms appeared venous and Computed Tomography Angiography located the catheter in the left internal jugular vein, but demonstrated that the tip of the catheter was lying over a left pulmonary vein which was abnormally draining into the left brachiocephalic (innominate) vein rather than into the left atrium.

Conclusion

Although several mechanical complications of dialysis catheters have been described, ours is one of the few cases of malposition into an anomalous pulmonary vein, and highlights a sequential approach to properly identify the catheter location in this uncommon clinical scenario.

【 授权许可】

   
2014 Chirinos et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Choi JI, Cho SG, Yi JH, Han SW, Kim HJ: Unintended cannulation of the subclavian artery in a 65-year-old-female for temporary hemodialysis vascular access: management and prevention. J Korean Med Sci 2012, 27(10):1265-1268.
• [2]Choi YS, Park JY, Kwak YL, Lee JW: Inadvertent arterial insertion of a central venous catheter: delayed recognition with abrupt changes in pressure waveform during surgery -A case report. Korean J Anesthesiol 2011, 60(1):47-51.
• [3]Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG: Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med 2007, 33(6):1055-1059.
• [4]Pikwer A, Acosta S, Kolbel T, Malina M, Sonesson B, Akeson J: Management of inadvertent arterial catheterisation associated with central venous access procedures. Eur J Vasc Endovasc Surg 2009, 38(6):707-714.
• [5]Seldinger SI: Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol 1953, 39(5):368-376.
• [6]Wadhwa R, Toms J, Nanda A, Abreo K, Cuellar H: Angioplasty and stenting of a jugular-carotid fistula resulting from the inadvertent placement of a hemodialysis catheter: case report and review of literature. Semin Dial 2012, 25(4):460-463.
• [7]Gilbert TB, Seneff MG, Becker RB: Facilitation of internal jugular venous cannulation using an audio-guided Doppler ultrasound vascular access device: results from a prospective, dual-center, randomized, crossover clinical study. Crit Care Med 1995, 23(1):60-65.
• [8]Milling TJ Jr, Rose J, Briggs WM, Birkhahn R, Gaeta TJ, Bove JJ, Melniker LA: Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med 2005, 33(8):1764-1769.
• [9]Sobrinho G, Salcher J: Partial anomalous pulmonary vein drainage of the left lower lobe: incidental diagnostic after central venous cannulation. Crit Care Med 2003, 31(4):1271-1272.
• [10]Jobes DR, Schwartz AJ, Greenhow DE, Stephenson LW, Ellison N: Safer jugular vein cannulation: recognition of arterial puncture and preferential use of the external jugular route. Anesthesiology 1983, 59(4):353-355.
• [11]Aghdami A, Ellis R: High oxygen saturation does not always indicate arterial placement of catheter during internal jugular venous cannulation. Anesthesiology 1985, 62(3):372-373.
• [12]Chintu MR, Chinnappa S, Bhandari S: Aberrant positioning of a central venous dialysis catheter to reveal a left-sided partial anomalous pulmonary venous connection. Vasc Health Risk Manag 2008, 4(5):1141-1143.
• [13]Boardman P, Hughes JP: Radiological evaluation and management of malfunctioning central venous catheters. Clin Radiol 1998, 53(1):10-16.
• [14]Patel RY, Friedman A, Shams JN, Silberzweig JE: Central venous catheter tip malposition. J Med Imag Radiat Oncol 2010, 54(1):35-42.
• [15]Gibson F, Bodenham A: Misplaced central venous catheters: applied anatomy and practical management. Br J Anaesth 2013, 110(3):333-346.
• [16]Guilbert MC, Elkouri S, Bracco D, Corriveau MM, Beaudoin N, Dubois MJ, Bruneau L, Blair JF: Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg 2008, 48(4):918-925. discussion 925
• [17]Sasikumar N, Ramanan S, Chidambaram S, Rema KM, Cherian KM: Bilateral anomalous pulmonary venous connection to bilateral superior caval veins. World J Pediatr Congenit Heart Surg 2014, 5(1):124-127.
• [18]ElBardissi AW, Dearani JA, Suri RM, Danielson GK: Left-sided partial anomalous pulmonary venous connections. Ann Thorac Surg 2008, 85(3):1007-1014.