The procedure was uneventful except for a slight initial resistance to retrieve the guidewire. The insertion was achieved in one attempt by an experienced anesthesiologist and according to the hospital protocol. Braun), using anatomical landmarks and Seldinger technique. After induction of anesthesia, a 7.0-French triple lumen central venous catheter was inserted in the right internal jugular vein (Certofix (r) Trio - B. Her past medical history included morbid obesity (weight 110 kg, height 150 cm), ischemic heart disease with angina on moderate exertion, diabetes mellitus, chronic obstructive pulmonary disease and hypothyroidism.Ī central venous catheter was indicated because of difficulty in obtaining a peripheral access and the possible need for vasopressor therapy. After unsuccessful attempt to remove it by colonoscopy, she was proposed for exploratory laparotomy. A foreign body (chicken bone) was found jammed at the sigmoid. Case report 2Ī 67-year-old woman, ASA III, presented to the emergency department because of a 2-week history of abdominal pain and diarrhea. The chest tube was removed after 5 days and she was discharged, fully recovered. Portable chest X-ray showing right hydrothorax 9 h after insertion of the central venous catheter.Ī chest tube was inserted with immediate drainage of 2500 mL of serous fluid accompanied by symptomatic relieve. The chest radiograph showed opacity on the right hemithorax and the catheter tip was noted to be in the opposite direction of the cardiac silhouette ( Fig. Central venous catheter was not permeable and no blood return was achieved. At auscultation there were no breath sounds in the right hemithorax with dullness at percussion. Later in the post-anesthetic care unit, 6 h after surgery, the patient complained of right chest pain and dyspnea. The central venous pressure was kept below 5 mmHg, without the need for vasodilators.Īt the end of the procedure the patient was awake with no signs of respiratory distress. Central venous pressure monitoring was attached to the distal port. At this point free blood return was observed from proximal and middle catheter ports, but not from the distal one. Case report 1Ī 33-year-old woman, ASA ( American Society of Anesthesiologists physical status classification) I, weight 54 kg, height 155 cm, with hepatic adenoma presented for elective left hepatectomy.Īfter induction of anesthesia, a 7.0-French triple lumen central venous catheter was inserted in the right internal jugular vein (Certofix (r) Trio - B. We present two cases of rare complications associated with catheterization of the right internal jugular vein, intending to emphasize the importance of ascertaining the patency of each port before proceeding with its use, even when there were no difficulties in the technique. including thrombosis, infection, obstruction, and mechanical complications that commonly occur during insertion and which depend on the anatomical relations of the central veins. Preventing complications of central venous catheterization. Overall this technique has a complication rate of about 15%, 1 1. Central venous catheterization is a common procedure in anesthesia practice, used for therapeutic and diagnostic purposes, such as monitoring of central venous pressure, and perioperative fluid and drug administration.
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