Document Detail

Cerebrovascular events associated with infusion through arterially malpositioned triple-lumen catheter: report of three cases and review of literature.
MedLine Citation:
PMID:  16230888     Owner:  NLM     Status:  MEDLINE    
Analysis of 10 adult patients treated from January 1998 to November 2004 for arterial misplacement of triple-lumen catheter (TLC) during internal jugular vein cannulation was performed. Three cases that developed neurologic symptoms occurring in the context of infusion through a TLC that was arterially malpositioned are presented, along with the review of literature. In 7 patients, the diagnosis of arterial misplacement was suspected by the color or flow characteristics of blood and confirmed by a combination of blood gas analysis, connecting catheter to transducer, and/or chest film. In the remaining 3 patients, intraarterial misplacement was not suspected. In these patients, the initial review of chest films by qualified physicians prior to starting infusion failed to detect malposition of the catheter. Retrospectively, subtle clues suggestive of arterially placed TLCs were found. All 3 patients developed neurologic symptoms. Initiation of neurologic workup delayed a correct diagnosis by 6 to >48 hours. A volumetric pump was used for infusion in all patients. Of the 3 patients with neurologic symptoms, 1 recovered completely, 1 became comatose, and 1 partially improved. Based on our observations and review of literature, we conclude that cursory examination of chest films to verify proper positioning of central venous catheter attempted through the internal jugular vein may fail to detect arterial malposition. Infusion by volumetric pump precludes backflow of blood in the intravenous tubing as an indicator. Neurologic symptoms concurrent with the infusion of fluids and medication should raise suspicion of accidental arterial infusion.
Pravin M Shah; Benjamin Leong; Sateesh C Babu; Arun M Goyal; Romeo B Mateo
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Cardiology in review     Volume:  13     ISSN:  1061-5377     ISO Abbreviation:  Cardiol Rev     Publication Date:    2005 Nov-Dec
Date Detail:
Created Date:  2005-10-18     Completed Date:  2006-05-22     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  9304686     Medline TA:  Cardiol Rev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  304-8     Citation Subset:  IM    
Department of Surgery, New York Medical College, Valhalla, NY, USA.
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MeSH Terms
Antineoplastic Agents / administration & dosage*
Catheterization, Central Venous / adverse effects*
Catheters, Indwelling / adverse effects*
Cerebrovascular Disorders / etiology*,  radiography
Infusions, Intra-Arterial / adverse effects
Jugular Veins
Middle Aged
Ovarian Neoplasms / drug therapy,  radiography
Rectal Neoplasms / drug therapy,  radiography
Retrospective Studies
Tomography, X-Ray Computed
Reg. No./Substance:
0/Antineoplastic Agents

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