Document Detail

Accidental insertion of a percutaneous venovenous cannula into the persistent left superior vena cava of a patient undergoing liver transplantation.
MedLine Citation:
PMID:  21553167     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Persistent left superior vena cava (PLSVC) is a rare congenital vascular abnormality found in 0.3% of the general population. We report herein a rare complication involving the accidental insertion of a large bore cannula into the PLSVC during liver transplantation (LT).
CLINICAL FEATURES: A 63-yr-old man with primary sclerosing cholangitis presented for LT. Given the existence of a tunnelled dialysis catheter in the right internal jugular vein (IJV) and a triple lumen catheter via the left IJV, insertion of an 18 French cannula for venovenous bypass (VVB) was performed via the left IJV using the existing triple lumen cannula as a conduit for a guidewire. Upon initiation of VVB, profound systemic hypotension occurred, and liver transplantation was completed without the further use of VVB. A chest x-ray confirmed a malposition of the VVB cannula with a large left hemothorax. A mini-sternotomy was performed for removal of the VVB cannula, which was found to be inserted in the PLSVC. Retrospectively, the presence of PLSVC was not anticipated due to a normal superior vena cava and a left innominate vein, as revealed by the course of a pre-existing left internal jugular vein triple lumen catheter on a preoperative chest x-ray, and due to a normal-sized coronary sinus on preoperative echocardiography.
CONCLUSION: Malpositioning of a venous cannula in a PLSVC should be anticipated as one of the potential complications of vascular access via the left internal jugular vein.
Kristin L Schreiber; Takashi Matsusaki; Brian C Bane; Christian A Bermudez; Ibtesam A Hilmi; Tetsuro Sakai
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2011-05-07
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  58     ISSN:  1496-8975     ISO Abbreviation:  Can J Anaesth     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-23     Completed Date:  2011-10-24     Revised Date:  2012-02-23    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  646-9     Citation Subset:  IM    
Department of Anesthesiology, The McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore, M469.11, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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MeSH Terms
Catheterization, Central Venous / adverse effects*
Cholangitis, Sclerosing / surgery
Hypotension / etiology
Jugular Veins
Liver Transplantation / methods*
Medical Errors
Middle Aged
Vena Cava, Superior / abnormalities*
Comment In:
Can J Anaesth. 2012 Feb;59(2):232-3; author reply 233   [PMID:  22228294 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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