Brachiocephalic Vein Perforation During Cannulation of Internal Jugular Vein: A Case Report

Massive hemothorax following internal jugular vein catheterization under ultrasound guidance: A case report

BACKGROUND

Hemothorax is a rare but life-threatening complication of central venous catheterization. Recent reports suggest that ultrasound guidance may reduce complications however, it does not guarantee safety

CASE SUMMARY

A 75-year-old male patient was admitted for laparoscopic radical nephrectomy. Under ultrasound guidance, right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt. Sudden hypotension developed after surgical positioning and persisted until the end of the operation, lasting for about 4 h. In the recovery room, a massive hemothorax was identified on chest radiography and computed tomography. The patient recovered following chest tube drainage of 1.6 L blood.

CONCLUSION

Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance. So the proper use of ultrasound is important

A Rare Complication of Internal Jugular Vein Cannulation Following Subcutaneous Implanted Port Placement

Port-a-Cath also known as a subcutaneous implantable catheter is a common device used in patients undergoing drug infusions. Port-a-Cath placements are widely used among cancer patients who need multiple intravenous infusions with chemotherapeutic agents. The surgical approach to implanting a Port-a-Cath is associated with risks and benefits; however, it may also be associated with serious complications. We describe a rare case of a large right-sided hemothorax following right internal jugular vein cannulation after Port-a-Cath placement. We discuss possible causes of hemothorax in this patient and describe possible factors such as abnormal anatomy of vessels and body habitus contributing to this complication. We also highlight the use of imaging such as ultrasound-guided techniques and the importance of postoperative chest radiographs to screen for possible complications.

Effects of ipsilateral tilt position on the cross-sectional area of the subclavian vein and the clinical performance of subclavian vein catheterization: a prospective randomized trial

BACKGROUND

The cross-sectional area of the subclavian vein (csSCV) is a crucial factor in the successful catheterization of the subclavian vein. This randomized controlled study investigated the effects of the csSCV on landmark-based subclavian vein catheterization.

METHODS

This study was performed using a two-stage protocol. During stage I, the csSCV was measured in 17 patients placed in the supine, 20° ipsilateral tilt, and 20° contralateral tilt positions in a random order. During stage II, landmark-based subclavian vein catheterization was randomly performed in patients placed in either the supine (group S, n = 107) or the ipsilateral tilt (group I, n = 109) position. The primary outcome measure was the csSCV in stage I and the primary venipuncture success rate in stage II. Secondary outcome measures were the time to successful venipuncture, the total catheterization time, the first-pass success rate, and the incidence of mechanical complications during catheterization.

RESULTS

The csSCV was significantly larger in the ipsilateral tilt than in either the supine or contralateral tilt position (1.01 ± 0.35 vs. 0.84 ± 0.32 and 0.51 ± 0.26 cm², P = .006 and < .001, respectively). The primary venipuncture success rate did not differ significantly between the group S and I (57.0 vs. 64.2%, P = .344). There were also no significant differences in the secondary outcome measures of the two groups.

CONCLUSIONS

The csSCV was significantly larger in patients placed in the ipsilateral tilt than in the supine position, but the difference did not result in better clinical performance of landmark-based subclavian vein catheterization.

TRIAL REGISTRATION

NCT03296735 for stage I ( ClinicalTrials.gov , September 28, 2017) and NCT03303274 for stage II ( ClinicalTrials.gov , October 6, 2017).