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Rare malposition of central venous catheter
,
Nebojša Videnović
,
Bojan Stojićević
,
Ranko Zdravković
Jovan Mladenović
Abstract
Uvod: Iako je plasiranje centralnog venskog katetera rutinska procedura koju izvode anesteziolozi, ono nosi određeni rizik od komplikacija. Jedna od komplikacija je malpozicija, odnosno neadekvatna pozicija katetera. Prikaz slučaja: Predstavljamo slučaj pacijentkinje koja je primljena u jedinicu intenzivne nege zbog povrede glave i povraćanja sveže krvi. Plasiran joj je centralni venski kateter kroz desnu unutrašnju jugularnu venu. Zbog hemodinamske nestabilnosti i potrebe za ordiniranjem tečnosti i krvi, nije odmah urađen RTG snimak grudnog koša radi procene položaja katetera. Nakon stabilizacije pacijentkinje, urađen je RTG snimak koji je pokazao da se vrh katetera ne nalazi u gornjoj šupljoj veni već u desnoj veni subklaviji. Zaključak: Ovaj slučaj je pokazao da vrh centralnog venskog katetera ne završi uvek u gornjoj šupljoj veni. Kada se nalazi u venskom sistemu, čak i kada nije u gornjoj šupljoj veni, može u urgentnim situacijama poslužiti za inicijalnu nadoknadu tečnosti i aplikovanje lekova, a po stabilizaciji pacijenta treba razmotriti repoziciju ili plasiranje novog katetera. Ključne reči: unutrašnja jugularna vena, vena subclavia, malprezentacija, venski kateter AUTORI SUMARY SRPSKI Introduction: Although placement of the central venous catheter is a routine procedure carried out by anesthesiologists, it carries a certain risk of complications. One of the complications is malposition, or inadequate catheter position. Case report: We present a case of the patient who was admitted to an intensive care unit due to head injury and blood vomiting. The central venous catheter was inserted through the right internal jugular vein. Due to haemodynamic instability and the need for fluid and blood infusion, a chest x-ray examination was not immediately performed to evaluate the position of the catheter. After the patient was stabilized, the test was performed and revealed that the tip of the catheter was not located in the superior vena cava but in the right subclavian vein. Conclusion: This case has shown that the misplacement of the central venous catheter tip is not unusual. Once in the venous system, even when it is not located in the superior vena cava, it can be used for initial fluid replacement and drug administration, and after the patient is stabilized, the repositioning or placement of a new catheter should be considered.
Keywords
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