Department of Anesthesiology and Operative Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany.
J Vasc Access. 2022 May;23(3):474-476. doi: 10.1177/1129729821998531. Epub 2021 Mar 1.
Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications.Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved.While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture.In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.
中心静脉导管（CVC）广泛应用于危重症患者和接受大手术的患者。在 CVC 插入过程中，针插入可能导致气胸和血胸等严重不良事件。导管位置不当的情况较少被描述，但同样重要，因为它可能导致有害的并发症。在这里，我们描述了一例经锁骨下穿刺右腋静脉后导丝位置不当的病例，该病例通过连续超声采用锁骨上窝视图检测到。利用这种超声视图，改变了插入血管的方法，从而可以实现正确的 CVC 放置。虽然超声引导广泛应用于血管穿刺，但该病例证明了在整个 CVC 插入过程中连续超声引导的价值：血管穿刺、正确的导丝推进、导管放置以及排除气胸等并发症。它还表明，即使在成功的静脉穿刺后，也应高度怀疑导丝位置不当。总之，应将涵盖完整 CVC 插入过程的超声方案纳入当前的临床实践中。
