Inadvertent catheter misplacement into the subclavian artery during ultrasound-guided internal jugular venous catheterization: a case report

Tomoki Kohyama; Keisuke Fujimaki; Hiroki Sasamori; Joho Tokumine; Kiyoshi Moriyama; Tomoko Yorozu

doi:10.1186/s40981-023-00649-1

Inadvertent catheter misplacement into the subclavian artery during ultrasound-guided internal jugular venous catheterization: a case report

JA Clin Rep. 2023 Sep 6;9(1):58. doi: 10.1186/s40981-023-00649-1.

Authors

Tomoki Kohyama¹, Keisuke Fujimaki², Hiroki Sasamori³, Joho Tokumine⁴, Kiyoshi Moriyama⁵, Tomoko Yorozu⁵

Affiliations

¹ Department of Anesthesia, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014, Japan.
² Department of Cardiovascular Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
³ Department of Neurosurgery, Hayama Heart Center, 1898-1 Shimoyamaguchi, Hayama, Miura, Kanagawa, 240-0116, Japan.
⁴ Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan. dg274825@cf6.so-net.ne.jp.
⁵ Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.

Abstract

Background: Ultrasound-guided central venous catheterization has become a standard procedure. However, mechanical complications are still reported.

Case presentation: An 85-year-old woman presented with coagulopathic bladder tamponade. Ultrasound-guided right internal jugular venous catheterization was planned because of difficult peripheral venous access. A guidewire was advanced through a needle inserted at the midpoint of the right carotid triangle. The guidewire was identified in the short axis, but not in the long-axis ultrasound view, leading to inadvertent insertion of the catheter into the right subclavian artery through the internal jugular vein. Stent graft insertion was performed for perforation closure. The patient exhibited no symptoms of cerebral ischemia following stent graft insertion.

Discussion: This case demonstrated that the needle-sticking site should not be placed close to the clavicle for ultrasound-guided internal jugular venous catheterization, as it may not confirm the position of guidewire in the long-axis ultrasound view.

Keywords: Guidewire; Low approach; Mechanical complication; Ultrasound-guided internal jugular venous catheterization.