Deng Haihui, Chen Bin, Peng Deti, Pang Fuwen
Department of Interventional Radiology, Shenzhen Traditional Chinese Medicine Hospital, No.1 Fuhua Rd, Shenzhen, 518033, China.
Department of Liver Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518033, China.
Int J Emerg Med. 2024 Oct 8;17(1):145. doi: 10.1186/s12245-024-00744-9.
Central venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment.
A 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient's vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient's continued stability.
This case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure's accuracy and safety.
中心静脉置管对于设备插入、监测、给药和液体复苏至关重要，通常使用锁骨下静脉、颈内静脉和股静脉。尽管其总体安全性较高，但诸如动脉穿刺等并发症可能危及生命，需要快速诊断和治疗。
一名74岁处于脑梗死恢复期的女性接受了右锁骨下静脉置管。经计算机断层扫描（CT）和数字减影血管造影（DSA）证实，导管误置于头臂干，其尖端位于升主动脉。鉴于手术风险高且血管内治疗复杂，选择了更换导管。首次置管一个月后，更换为较小的导管，又过了一个月，导管回撤，未出现并发症。随访CT和DSA显示无渗漏，患者生命体征保持稳定。出院后三个月的电话随访证实患者持续稳定。
本病例表明，当其他选择不切实际时，导管更换技术作为一种微创修复方法可有效应用。还建议使用超声引导以提高操作的准确性和安全性。
