Lim Jung A, Jee Chan Hee, Kwak Kyung-Hwa
Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Medicine (Baltimore). 2017 Jun;96(24):e7187. doi: 10.1097/MD.0000000000007187.
The misplacement of central venous catheter (CVC) can occur more often at the left jugular vein than the right side due to anatomic differences. And many of the previously reported cases are about catheter misplacement resulting from vessel penetration associated with guidewire. This case differs that the catheter itself through the sheath introducer can cause venous injury that may lead to the malposition of CVC particularly through an approach to the left internal jugular vein.
PATIENT CONCERNS, DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: We cannulated a large-bore CVC with a sheath introducer, namely mult-lumen access catheter (MAC) in the left jugular vein of patient under anesthesia using ultrasound and inserted the additional central venous oximetry catheter through the sheath introducer of MAC and confirmed aspiration of blood. However, the postoperative imaging study revealed malposition of the tip of the oximetry catheter in the mediastinum.
The insertion of additional catheter through the sheath introducer needs to be carried out as carefully as the insertion of guidewire and should be confirmed with imaging study after the procedure.
由于解剖学差异，中心静脉导管（CVC）误置于左颈静脉的情况比右侧更为常见。而且先前报道的许多病例是关于与导丝相关的血管穿透导致的导管误置。本病例的不同之处在于，导管本身通过鞘管导入器可导致静脉损伤，这可能导致CVC位置异常，尤其是通过左颈内静脉入路时。
患者情况、诊断、干预措施及结果：我们在超声引导下，于麻醉状态下的患者左颈静脉使用鞘管导入器（即多腔接入导管，MAC）插入一根大口径CVC，并通过MAC的鞘管导入器插入额外的中心静脉血氧饱和度导管，并确认回血。然而，术后影像学检查显示血氧饱和度导管尖端位于纵隔内，位置异常。
通过鞘管导入器插入额外导管时，应像插入导丝一样谨慎操作，并在术后通过影像学检查进行确认。
