1
|
Shah Z, Khan I, Dixe de Oliveira Santo I. Intraperitoneal Hematoma After Femoral Catheterization: A Case Report and Literature Review. Cureus 2022; 14:e25140. [PMID: 35733506 PMCID: PMC9205448 DOI: 10.7759/cureus.25140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
Central venous catheters (CVCs) are often crucial in managing severely ill patients, especially those in the intensive care unit. It is estimated that over 5 million CVCs are inserted per year in the United States. The internal jugular, subclavian, or femoral veins are the most used access sites. The catheter is advanced until its tip lies within the proximal third of the superior vena cava, the right atrium, or the inferior vena cava. Unfortunately, the use of CVCs is not without its drawbacks, and multiple immediate and delayed complications have been described. Herein, we report a case of a 70-year-old female with a past medical history significant for chronic obstructive pulmonary disease, coronavirus disease 2019, pneumonia, type 2 diabetes mellitus, and hypertension, who presented to the emergency department from a skilled nursing facility with a two-day history of dyspnea. She was later diagnosed with an intraperitoneal hematoma, an uncommon complication caused by a CVC placement.
Collapse
|
2
|
Coskun A, Hıncal SÖ, Eren SH. Emergency service results of central venous catheters: Single center, 1042 patients, 10-year experience. World J Crit Care Med 2021; 10:120-131. [PMID: 34316447 PMCID: PMC8291001 DOI: 10.5492/wjccm.v10.i4.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/29/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Central venous catheterization is currently an important procedure in critical care. Central catheterization has important advantages in many clinical situations. It can also lead to different complications such as infection, hemorrhage, and thrombosis. It is important to investigate critically ill patients undergoing catheterization.
AIM To evaluate the characteristics, such as hospitalization, demographic characteristics, post-catheterization complications, and mortality relationships, of patients in whom a central venous catheter was placed in the emergency room.
METHODS A total of 1042 patients over the age of 18 who presented to the emergency department between January 2005 and December 2015 were analyzed retrospectively. The patients were divided into three groups, jugular, subclavian, and femoral, according to the area where the catheter was inserted. Complications related to catheterization were determined as pneumothorax, guidewire problems, bleeding, catheter site infection, arterial intervention, and sepsis. Considering the treatment follow-up of the patients, three groups were formed as outpatient treatment, hospitalization, and death.
RESULTS The mean age of the patients was 60.99 ± 19.85 years; 423 (40.6%) of them were women. Hospitalization time was 11.89 ± 16.38 d. There was a significant correlation between the inserted catheters with gender (P = 0.009) and hospitalization time (P = 0.040). Also, blood glucose, blood urea nitrogen, creatinine, and serum potassium values among the biochemical values of the patients who were catheterized were significant. A significant association was observed in the analysis of patients with complications that develop according to the catheter region (P = 0.001) and the outcome stage (P = 0.001). In receiver operating characteristic curve analysis of hospitalization time and mortality area under curve was 0.575, the 95% confidence interval was 0.496-0.653, the sensitivity was 71%, and the specificity was 89% (P = 0.040).
CONCLUSION Catheter location and length of stay are important risk factors for catheter-borne infections. Because the risk of infection was lower than other catheters, jugular catheters should be preferred at entry points, and preventive measures should be taken by monitoring patients closely to reduce hospitalization infections.
Collapse
Affiliation(s)
- Abuzer Coskun
- Emergency Medicine Clinic, SBU Istanbul Bağcılar Training and Research Hospital, Istanbul 34200, Turkey
| | - Sakir Ömür Hıncal
- Emergency Medicine Clinic, SBU Istanbul Bağcılar Training and Research Hospital, Istanbul 34200, Turkey
| | - Sevki Hakan Eren
- Department of Emergency, Gaziantep University Medical Faculty, Gaziantep 27410, Turkey
| |
Collapse
|
3
|
Shafiee H, Safari S, Aminnejad R. Intraperitoneally Located Tip of Femoral Vein Catheter; Clinical Suspicion for Avoidance of Unnecessary Laparotomy. Anesth Pain Med 2017; 7:e64557. [PMID: 29696130 PMCID: PMC5903375 DOI: 10.5812/aapm.64557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/16/2017] [Indexed: 11/18/2022] Open
Abstract
Central venous catheterization is a common procedure in critical care and trauma patients. Complications are not rare and in some studies more than 15% incidence has been reported (1). Femoral vein is one of the commonest site for this purpose yet it carries complications, such as infection and misplacement. The current study reports an unexpected secondary malposition of right femoral CVC in the peritoneal cavity. It was concluded that in any case of acute abdominal issues, following insertion of femoral venous catheter, evaluation of catheter misplacement by the means of contrast injection through it can be helpful for better diagnosis, and may help avoid unnecessary surgical interventions.
Collapse
Affiliation(s)
- Hamed Shafiee
- Department of Anesthesiology, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Saeid Safari
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Aminnejad
- Department of Anesthesiology, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
- Corresponding author: Reza Aminnejad, M.D., Department of Anesthesiology, Shahid Beheshti Hospital, Qom, Iran. E-mail:
| |
Collapse
|
4
|
Daureeawoo R, Baliga S, Mohahmed W, Ahmed EB. A case report of an unusual cause of postoperative leg pain after posterior lumbar fusion. Ann Med Surg (Lond) 2017; 19:29-32. [PMID: 28616222 PMCID: PMC5458057 DOI: 10.1016/j.amsu.2017.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/19/2017] [Accepted: 05/20/2017] [Indexed: 11/28/2022] Open
Abstract
We report the case of a 36-year old man who underwent elective posterior lumbar spinal fusion after presenting with bilateral leg pain with associated back pain. He had undergone a L5/S1 discectomy in 2001, which provided good symptomatic relief. On this admission, he underwent elective L4-S1 posterolateral fusion and bilateral L4/5 and L5/S1 decompression. Intra-operatively a pedicle screw had to be re-inserted after fluoroscopy confirmed a lateral breech. The patient had no major postoperative complications until the sixth day when the patient re-presented with acute leg pain and weakness. Following a local multidisciplinary meeting (MDT) an MRI showed a large haematoma at the right psoas muscle. CT angiogram confirmed a bleeding lumbar segmental vessel at the site of the previous misplaced screw and an emergency fluoroscopic guided embolisation of the vessel was performed. The patient recovered well post operatively and was discharged back to the community 12 days later. Haemorrhage, as in this case a psoas haematoma should be considered as one of the differentials in patients with recurrent post-operative radiculopathy following posterior lumbar spine fusion. This should be suspected particularly if there has been a misplacement of one or more screws as this can cause injury to blood vessels and be fatal for the patient.
Collapse
Affiliation(s)
- R Daureeawoo
- Spinal Surgery Unit, Department of Trauma and Orthopaedics, University Hospitals of North Midlands NHS Trust, Newcastle Road, Stoke-on-Trent, ST4 6QG, United Kingdom.,Accident & Emergency Department, University Hospitals of North Midlands NHS Trust, United Kingdom
| | - S Baliga
- Spinal Surgery Unit, Department of Trauma and Orthopaedics, University Hospitals of North Midlands NHS Trust, Newcastle Road, Stoke-on-Trent, ST4 6QG, United Kingdom
| | - W Mohahmed
- Department of General Surgery, University Hospitals of North Midlands NHS Trust, United Kingdom
| | - E B Ahmed
- Spinal Surgery Unit, Department of Trauma and Orthopaedics, University Hospitals of North Midlands NHS Trust, Newcastle Road, Stoke-on-Trent, ST4 6QG, United Kingdom
| |
Collapse
|
5
|
Czyzewska D, Ustymowicz A, Klukowski M. [Application of ultrasonography in central venous catheterization; access sites and procedure techniques]. Med Clin (Barc) 2016; 147:116-20. [PMID: 27157792 DOI: 10.1016/j.medcli.2016.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022]
Abstract
Central venous catheterization is commonly performed in clinical practice. Traditional procedural technique is based on anatomical landmarks, but is associated with a high risk of failure and complications. To decrease their incidence European and American societies recommend application of ultrasonography. Preliminary ultrasonographic examination allows for assessment of local anatomical relations as well as vessel morphology (diameter, patency), while real-time ultrasonography increases chances of successful needle insertion. This paper presents the most common venous access sites and procedure techniques.
Collapse
Affiliation(s)
- Dorota Czyzewska
- Department of Diagnostic Imaging, Independent Public Provincial Hospital of J. Sniadecki, Bialystok, Polonia.
| | - Andrzej Ustymowicz
- Department of Radiology, Medical University of Bialystok, Bialystok, Polonia
| | - Mark Klukowski
- Department of Pediatrics, Gastroenterology, and Allergology, Medical University of Bialystok, Bialystok, Polonia
| |
Collapse
|
6
|
Bhatia N, Sivaprakasam J, Allford M, Guruswamy V. The relative position of femoral artery and vein in children under general anesthesia--an ultrasound-guided observational study. Paediatr Anaesth 2014; 24:1164-8. [PMID: 25041454 DOI: 10.1111/pan.12486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Femoral artery overlaps femoral vein by varying degrees distal to the inguinal ligament, which may result in difficult venous access and also increases the risk of arterial puncture. OBJECTIVE To study the size of femoral vessels and the degree of overlap in children undergoing anesthesia using ultrasound at 1 and 3 cm distal to inguinal ligament. METHODS A prospective observational study, 84 children aged <7 years were recruited in six different age groups. An experienced anesthetist identified the femoral vessels and their overlap using ultrasound at two fixed points distal to the inguinal ligament. We also evaluated the correlation of skin puncture site marked as per Advanced Paediatric Life support (APLS) guidance using landmark technique with the ultrasound location of femoral vein beneath the same site. RESULTS The percentage of children with overlap of femoral vein by femoral artery increases from 5% to 60% as we move distal to the inguinal ligament. At 3 cm distal to inguinal ligament, the incidence of any degree of overlap was statistically significant (P < 0.05) in children <5 years. In 80% of children, the femoral vein was located by ultrasound beneath the skin puncture site as recommended by APLS guidelines. CONCLUSION A significant increase in femoral vein overlap occurs as we move distal to the inguinal ligament. There is one in five chance of failure to locate femoral vein by landmark technique. In children <2 years, a high approach to femoral vein cannulation under ultrasound guidance is recommended.
Collapse
Affiliation(s)
- Nandlal Bhatia
- Department of Anaesthesia, Leeds General Infirmary, Leeds, UK
| | | | | | | |
Collapse
|
7
|
Vinson DR, Ballard DW, Stevenson MD, Mark DG, Reed ME, Rauchwerger AS, Chettipally UK, Offerman SR. Predictors of unattempted central venous catheterization in septic patients eligible for early goal-directed therapy. West J Emerg Med 2014; 15:67-75. [PMID: 24578768 PMCID: PMC3935788 DOI: 10.5811/westjem.2013.8.15809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 07/08/2013] [Accepted: 08/13/2013] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Central venous catheterization (CVC) can be an important component of the management of patients with severe sepsis and septic shock. CVC, however, is a time- and resource-intensive procedure associated with serious complications. The effects of the absence of shock or the presence of relative contraindications on undertaking central line placement in septic emergency department (ED) patients eligible for early goal-directed therapy (EGDT) have not been well described. We sought to determine the association of relative normotension (sustained systolic blood pressure >90 mmHg independent of or in response to an initial crystalloid resuscitation of 20 mL/kg), obesity (body mass index [BMI] ≥30), moderate thrombocytopenia (platelet count <50,000 per μL), and coagulopathy (international normalized ratio ≥2.0) with unattempted CVC in EGDT-eligible patients. METHODS This was a retrospective cohort study of 421 adults who met EGDT criteria in 5 community EDs over a period of 13 months. We compared patients with attempted thoracic (internal jugular or subclavian) CVC with those who did not undergo an attempted thoracic line. We also compared patients with any attempted CVC (either thoracic or femoral) with those who did not undergo any attempted central line. We used multivariate logistic regression analysis to calculate adjusted odd ratios (AORs). RESULTS In our study, 364 (86.5%) patients underwent attempted thoracic CVC and 57 (13.5%) did not. Relative normotension was significantly associated with unattempted thoracic CVC (AOR 2.6 95% confidence interval [CI], 1.6-4.3), as were moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5-10.1) and coagulopathy (AOR 2.7; 95% CI, 1.3-5.6). When assessing for attempted catheterization of any central venous site (thoracic or femoral), 382 (90.7%) patients underwent attempted catheterization and 39 (9.3%) patients did not. Relative normotension (AOR 2.3; 95% CI, 1.2-4.5) and moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5-10.3) were significantly associated with unattempted CVC, whereas coagulopathy was not (AOR 0.6; 95% CI, 0.2-1.8). Obesity was not significantly associated with unattempted CVC, either thoracic in location or at any site. CONCLUSION Septic patients eligible for EGDT with relative normotension and those with moderate thrombocytopenia were less likely to undergo attempted CVC at any site. Those with coagulopathy were also less likely to undergo attempted thoracic central line placement. Knowledge of the decision-making calculus at play for physicians considering central venous catheterization in this population can help inform physician education and performance improvement programs.
Collapse
Affiliation(s)
- David R. Vinson
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Roseville Medical Center, Roseville, California
| | - Dustin W. Ballard
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente San Rafael Medical Center, San Rafael, California
| | | | - Dustin G. Mark
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Mary E. Reed
- Kaiser Permanente Division of Research, Oakland, California
| | | | - Uli K. Chettipally
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente South San Francisco Medical Center, South San Francisco, California
| | - Steven R. Offerman
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| |
Collapse
|
8
|
Murai Y, Adachi K, Yoshida Y, Takei M, Teramoto A. Retroperitoneal hematoma as a serious complication of endovascular aneurysmal coiling. J Korean Neurosurg Soc 2010; 48:88-90. [PMID: 20717521 DOI: 10.3340/jkns.2010.48.1.88] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/13/2010] [Accepted: 06/14/2010] [Indexed: 11/27/2022] Open
Abstract
Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.
Collapse
Affiliation(s)
- Yasuo Murai
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | | | | | | | | |
Collapse
|
9
|
Turan N, Oghan F, Boran T. Spontaneous rupture of splenic vein in a pregnant woman during a religious ritual. J Forensic Leg Med 2007; 14:440-3. [PMID: 17720597 DOI: 10.1016/j.jflm.2006.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 11/28/2006] [Accepted: 12/04/2006] [Indexed: 11/19/2022]
Abstract
The treatment of retroperitoneal hemorrhage can be by surgical or a conservative approach but the main problems about these cases are difficulty in diagnosis due to negative results after abdominal lavage and the difficulties in accessing the retroperitoneal area surgically. Retroperitoneal hemorrhage during pregnancy, occurring as a result of spontaneous rupture, is very rare event. Such cases require urgent operation and if not, result in high mortality. A twenty-eight year old pregnant woman was admitted to the hospital dead after collapsing at home during a religious ritual. No systemic or gynecological pathology had been diagnosed. No traumatic injury on her body was found at early postmortem examination. The pathologic findings found at the autopsy are; approximately 2.5 L of coagulated blood in the retroperitoneal region and 10-12 cm of haematoma at the hilum of spleen; dissection revealed a tear of 0.5 cm on lienal vein at a point 3 cm from the hilum. Surgical approach is the most important procedure for diagnosis and therapy of the bleeding. Autopsy may be only diagnostic technique in the case of retroperitoneal hemorrhage death when the death is so rapid that there is no time to intervene surgically.
Collapse
Affiliation(s)
- Nursen Turan
- Karadeniz Technical University, Medical Faculty, Forensic Medicine Department, Trabzon, Turkey.
| | | | | |
Collapse
|
10
|
Singh NP. Femoral venous cannulation. Paediatr Anaesth 2007; 17:809-10; author reply 810. [PMID: 17596230 DOI: 10.1111/j.1460-9592.2007.02223.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Courtney AE, Ingram PJ, Doherty CC. Delayed presentation of unusual arterial injury during femoral vein catheterization for haemodialysis access. Nephrol Dial Transplant 2005; 21:796-8. [PMID: 16326740 DOI: 10.1093/ndt/gfi300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
12
|
Jung B, Valette S, Ryckwaert Y, Capdevila X. [Iatrogenic retroperitoneal haematoma after emergency femoral vein catheterisation]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:1390-2. [PMID: 16099122 DOI: 10.1016/j.annfar.2005.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Accepted: 05/31/2005] [Indexed: 11/18/2022]
Abstract
We report a iatrogenic case of retroperitoneal haematoma consecutive to an emergency femoral venous catheterization. The indication of the catheterisation was a hemorrhagic shock after a dilapidating traumatism of leg in an obese patient in whom peripheric venous access was impossible and vascular filling urgent. In spite of the existence of an initial reassuring blood backward flow, a retroperitoneal haematoma had been constituted gradually and explained an absence of haemodynamic improvement in spite of the surgical haemostasis and an adapted intravascular filling. The CT scan showed an iatrogenic lesion of the right iliac vein and justified the immediate infusion stop. The femoral catheter was withdrawn at the 48th hour and the patient discharged at the 6th day.
Collapse
Affiliation(s)
- B Jung
- Département d'anesthésie-réanimation A, CHU Lapeyronie, 191, avenue Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France.
| | | | | | | |
Collapse
|
13
|
|