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Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Year : 2012  |  Volume : 15  |  Issue : 1  |  Page : 67-68
Incidental transarterial placement of a dialysis catheter into the femoral vein


1 Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, 04103 Leipzig, Germany
2 Department of Internal Medicine, University of Leipzig, Medical Faculty, 04103 Leipzig, Germany
3 Department of Diagnostic and Interventional Radiology, University of Leipzig, Medical Faculty, 04103 Leipzig, Germany

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Date of Web Publication5-Jan-2012
 

How to cite this article:
Huschak G, Pfeifer F, Mende L, Dazinger F, Kaisers UX, Laudi S. Incidental transarterial placement of a dialysis catheter into the femoral vein. Ann Card Anaesth 2012;15:67-8

How to cite this URL:
Huschak G, Pfeifer F, Mende L, Dazinger F, Kaisers UX, Laudi S. Incidental transarterial placement of a dialysis catheter into the femoral vein. Ann Card Anaesth [serial online] 2012 [cited 2019 Nov 18];15:67-8. Available from: http://www.annals.in/text.asp?2012/15/1/67/91487


A 42-year-old man without significant medical history was hospitalized with dyspnea and fever up to 40°C due to novel H1N1 influenza. Oxygenation became critical on day 5. For continuous veno-venous hemofiltration, a dialysis catheter was placed into the left femoral vein using a guidewire. After further detoriation of gas exchange with decreasing PaO 2 /FiO 2 -ratio (P/F) from 77 mmHg at admission to 42 mmHg, veno-venous extracorporeal membrane oxygenation (vv-ECMO) was initiated. Cranial, thoracic and abdominal computed tomography (CT) scans were obtained for focus identification and exclusion of intracranial pathology. For illustration of ECMO-cannula position, the CT scan was extended to the inguinal region. While identification of femoral vein is usually carried out by ultrasound, the course of the cannula and the position of the tip is mostly visualized by plain X-ray. In this case, the CT scan necessary for focus identification was used instead of an additional plain abdominal X-ray. Incidentally, the dialysis catheter placed with both openings in the femoral vein was passing through the left femoral artery [Figure 1]. The perforation was located at the root of the profunda femoral artery best visualized by 3D-reconstruction of the scan [Video 1]. Perfusion of the left leg was clinically not impaired. Renal replacement therapy (RRT) was stopped and the dialysis catheter was removed. Prolonged manual compression was necessary for stopping the arterial bleeding. Using ultrasound guidance, a new dialysis catheter was placed into the left femoral vein. At discharge, ultrasound examination of all vessels catheterized during the ICU stay revealed no pathology.
Figure 1: The dialysis catheter was placed in the left groin. It is located in the left femoral vein (a1, f7) passing through the left femoral artery (a2, b3, c4, d5, e6). Subsets a-d show coronar image reconstructions and e and f represent sagittal images. Femoral artery is recognized by the arterial phase of the contrast medium distribution (a2, d5). Perfusion of the lower left extremity was clinically not impaired

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RRT is used for fluid management and impaired renal function. [1] The venous access is essential for adequate delivery of RRT whereas the placement of a large bore catheter has its own risk. According to data of litigation against the NHS in England, cases with central venous (mis)-cannulation belong to the group of claims with the highest mean cost per closed claim. [2]

Hypovolemia, emergency procedures and missing ultrasound guidance increase the risk of arterial puncture and/or misplacement. [3] In the case reported, the lack of ultrasound guidance may have promoted the transarterial puncture. We report a clinically not recognized transarterial placement of a high-flow dialysis catheter into the femoral vein and visualize the course of the catheter. Likely, ultrasound guidance would have avoided this incident. [4]



 
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1.Schetz M. Non-renal indications for continuous renal replacement therapy. Kidney Int Suppl 1999;72:S88-94.  Back to cited text no. 1
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2.Cook TM, Bland L, Mihai R, Scott S. Litigation related to anaesthesia: An analysis of claims against the NHS in England 1995-2007. Anaesthesia 2009;64:706-18.  Back to cited text no. 2
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3.Pikwer A, Acosta S, Kölbel T, Malina M, Sonesson B, Akeson J. Management of inadvertent arterial catheterisation associated with central venous access procedures. Eur J Vasc Endovasc Surg 2009;38:707-14.  Back to cited text no. 3
    
4.Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical complications of central venous catheters. J Intensive Care Med 2006;21:40-6.  Back to cited text no. 4
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Correspondence Address:
Gerald Huschak
Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Liebigstr. 20, D 04103 Leipzig
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.91487

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