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Dialysis catheter placement via the left internal jugular vein: risk of brachiocephalic vein perforation.
J Vasc Access 2016; 17(4):e75-8JV

Abstract

PURPOSE

We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion.

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.

Authors+Show Affiliations

Department of Vascular Surgery, Máxima Medical Center, Veldhoven - The Netherlands.Department of Vascular Surgery, Máxima Medical Center, Veldhoven - The Netherlands.Department of Vascular Surgery, Máxima Medical Center, Veldhoven - The Netherlands. CARIM Research School, Maastricht University, Maastricht - The Netherlands.CARIM Research School, Maastricht University, Maastricht - The Netherlands. Cardiovascular Center, Catharina Hospital, Eindhoven - The Netherlands.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27197635

Citation

Winkes, Michiel B., et al. "Dialysis Catheter Placement Via the Left Internal Jugular Vein: Risk of Brachiocephalic Vein Perforation." The Journal of Vascular Access, vol. 17, no. 4, 2016, pp. e75-8.
Winkes MB, Loos MJ, Scheltinga MR, et al. Dialysis catheter placement via the left internal jugular vein: risk of brachiocephalic vein perforation. J Vasc Access. 2016;17(4):e75-8.
Winkes, M. B., Loos, M. J., Scheltinga, M. R., & 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), pp. e75-8. doi:10.5301/jva.5000566.
Winkes MB, et al. Dialysis Catheter Placement Via the Left Internal Jugular Vein: Risk of Brachiocephalic Vein Perforation. J Vasc Access. 2016 Jul 12;17(4):e75-8. PubMed PMID: 27197635.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dialysis catheter placement via the left internal jugular vein: risk of brachiocephalic vein perforation. AU - Winkes,Michiel B, AU - Loos,Maarten J, AU - Scheltinga,Marc R, AU - Teijink,Joep A, Y1 - 2016/07/12/ PY - 2016/03/28/accepted PY - 2016/5/21/entrez PY - 2016/5/21/pubmed PY - 2017/4/25/medline SP - e75 EP - 8 JF - The journal of vascular access JO - J Vasc Access VL - 17 IS - 4 N2 - PURPOSE: We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion. 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. SN - 1724-6032 UR - https://www.unboundmedicine.com/medline/citation/27197635/Dialysis_catheter_placement_via_the_left_internal_jugular_vein:_risk_of_brachiocephalic_vein_perforation_ L2 - http://journals.sagepub.com/doi/full/10.5301/jva.5000566?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -