Onuigbo Macaulay Amechi Chukwukadibia, Agbasi Nneoma, Sarki Bibek, Khan Sana, Wahlberg Kramer
The Robert Larner, M.D. College of Medicine, Department of Medicine, University of Vermont, Burlington, VT, UK.
Quality Improvement Programme, NELF NHS Foundation Trust, Basildon, Essex, UK.
Indian J Nephrol. 2020 Jan-Feb;30(1):29-31. doi: 10.4103/ijn.IJN_389_18. Epub 2019 Dec 27.
Internal jugular vein (IJV) cannulation was originally described by English . in 1969 as the safest approach. Carotid artery puncture had an incidence rate of 4-6% before ultrasound guidance. We encountered an unexpected sequence of events following the ultrasound-guided placement of a temporary HD catheter in the left IJV. The postprocedure chest radiograph was misinterpreted as an arterial misplacement, the blood return was correspondingly bright red, and simultaneous blood gas analyses from the left IJV catheter and a right radial artery were near mirror images. Subsequently, a transducer to the catheter showed a clearly venous waveform with a pressure of 40 mmHg. Thus, it was realized that the cacophony of missteps, misjudgments, and misinterpretations was due to the contiguous presence of a functional left brachio-axillary arteriovenous (AV) graft. To our knowledge, this is the first such report of this phenomenon of a pseudo-arterial central venous catheter placement in the IJV.
颈内静脉（IJV）插管最初由英国人于1969年描述为最安全的方法。在超声引导出现之前，颈动脉穿刺的发生率为4%-6%。在超声引导下将一根临时血液透析导管置入左侧颈内静脉后，我们遇到了一系列意外情况。术后胸部X光片被误判为动脉误置，回血相应地呈鲜红色，并且来自左侧颈内静脉导管和右侧桡动脉的同步血气分析结果近乎镜像。随后，在导管上使用换能器显示出一个清晰的静脉波形，压力为40 mmHg。因此，人们意识到，这一系列的失误、误判和误解是由于一条功能性左肱腋动静脉（AV）移植物的毗邻存在所致。据我们所知，这是首次报道颈内静脉出现假性动脉中心静脉导管置入这一现象。
