[Femoral venous catheter: an unusual complication]

A case report of abdominal compartment syndrome caused by malposition of a femoral venous catheter

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Venous catheter malposition is a rare event with potential catastrophic consequences.

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Catheter malposition can occur on induction or late.

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Ultrasound guided insertion offers extra safety in combination with clinical blood back-flow confirmation of intravascular placement.

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Periodical and systematic check of intravascular lines prior to their use can confirm positioning during patient transfers.

Introduction

Venous catheter malposition is a rare event with potential catastrophic consequences. To our knowledge we describe one of the first case reports of an adult presenting with a rare late complication of femoral venous catheter malposition: abdominal compartment syndrome.

Presentation of case

A 39 year-old female sustained severe cerebral injury in a road traffic accident. During initial resuscitation a femoral venous catheter was inserted without ultrasound guidance with no immediate concerns. After 48 h whilst in intensive care unit the patient developed progressive abdominal distension. Bedside investigations revealed raised intra-abdominal pressures associated with new organ failure. Subsequent an emergency laparotomy and on-table intravenous contrast radiographs revealed extravasation of contrast into the peritoneal space from the malposition of the catheter into the abdominal cavity.

Discussion

Complications of central venous catheterization are associated with adverse events with significant morbidity to the patient as well as having cost implications. Mechanical complications are underreported but are potentially preventable through ultrasound-guided insertion, in accordance with international guidelines.

Conclusion

This case report highlights the importance of safe methods of catheter insertion, the need for increased awareness of late femoral catheter malposition and its potential catastrophic consequences.