Koziatek Christian A, Idowu Damilola, White Richard
NYU School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York.
Bellevue Hospital Center, Department of Emergency Medicine, New York, New York.
Clin Pract Cases Emerg Med. 2023 Feb;7(1):51-53. doi: 10.5811/cpcem.2022.12.58202.
We describe a case of left internal jugular central venous access with rare malpositioning into the internal mammary vein. Despite various confirmatory measures at the time of placement including ultrasonography of the internal jugular vein, as well as blood gas analysis consistent with venous blood by oxygen saturation and good venous flow in all three ports of the catheter, subsequent imaging confirmed misplacement into the internal mammary vein.
Central venous access is a frequently used procedure by emergency physicians for a variety of indications. Emergency physicians must be facile with both the technical process of central venous catheter placement, as well as possible pitfalls and complications of the procedure. Common complications, such as bleeding, pneumothorax, arterial injury, infection, and hematomas, are usually well known; less frequently encountered is malposition of the catheter despite seemingly appropriate placement.
我们描述了一例左侧颈内静脉中心静脉置管罕见地误入乳内静脉的病例。尽管在置管时采取了各种确认措施，包括颈内静脉超声检查，以及通过氧饱和度和导管所有三个端口良好的静脉血流进行的血气分析，结果均符合静脉血，但后续成像证实导管误入了乳内静脉。
中心静脉置管是急诊医生因各种适应证而经常使用的操作。急诊医生必须熟练掌握中心静脉导管置管的技术过程以及该操作可能存在的陷阱和并发症。常见并发症，如出血、气胸、动脉损伤、感染和血肿，通常广为人知；尽管置管看似合适，但导管位置异常却较少见。
