Massive Hemoptysis during Catheteri...

Massive Hemoptysis during Catheterization of the Internal Jugular Vein

Cannulation of the internal jugular vein (IJV) is publicly accepted as a relatively safe manner of obtaining central venous access. [1] The principally common complication is carotid artery wound which is usually benign. [2] We report a case of massive hemoptysis, cervical hematoma and airway obstruction occurring during IJV catheterization.

CASE REPORT

A 51-year-old woman with a history of intravenous mix with drugs abuse was being treated for osteomyelitis with a six-week course of piperacillin, oxacillin, and gentamicin. fit to the need for lengthened antibiotic administration, catheterization of the right IJV for venous access was performed.

An 18-gauge needle was inserted via the anterior approach with immediate answer of venous blood. A 035 mm guidewire was threaded, the bottom dilated with a 7 French dilator, and a 7 French triple lumen catheter was inserted without difficulty. pop the patient complained of exact chest pain and turned her neck dislodging the catheter. She bl vigorously from the small hole site and developed a large cervical hematoma despite the application of urgency She rapidly became hypotensive and diaphoretic, and was treated with fluids and infusion of intravenous norepinephrine to maintain kindred pressure. She complained of shortness of breath, perform the operations indicated ined stridor, and had 300 to 400 ml of bright-red hemoptysis. The patient was intubated with a certain difficulty because of the amount of hemoptysis and transferred to the intensive care unit.

The norepinephrine infusion was rapidly tapered and discontinued. There was continued mild bleeding by means of the endotracheal tube which resolv across two hours. The patient's hematocrit value initially decreased from 40 to 30 percent then stabilized at 32 percent after transfusion of three units of packed r family cells. The patient's PT PTT and platelet cast were within normal limits.

The patient was not ever noted to have a carotid bruit or thrill. Angiography of the cervical and thoracic sailing crafts done two days later was normal and did not demonstrate an arteriovenous fistula. The chest roentgenogram revealed bilateral alveolar infiltrates consistent with family aspiration, which cleared over eight days. There was no evidence of air in the plastic tissues of neck, pneumothorax, or pneumomediastinum at any single in kind time. The cervical hematoma resolv slowly allowing the patient to be extubated after seven days, and resolving completely in three weeks.

DISCUSSION

Central venous catheterization of the IJV has a reasonable complication rate. [1] The greatest in quantity common complication is carotid artery small hole occurring in 4.2 percent of cases, usually without significant issues [2] Other complications include pneumothorax, thrombosis of the IJV, air embolus, and cerebrovascular accidents.

There have been reports of les oft-repeated but more serious, complications, of that kind as massive hemorrhage from carotid arteriotomy after attempted IJV cannulation in patients onward cardiopulmonary bypass. [3] Wiseheart et al [4] reported a death from massive hemorrhage after IJV cannulation secondary to wound of the ascending cervical artery with tears in the mediastinal and apical pleura and resultant hemothorax. Hansbrough et al [5] reported pair cases of presumed IJV-carotid artery fistulae manifested by way of cervical bruits. Cervical hematoma that caused airway obstruction requiring intubation was reported according to Knoblanche. [6] Two cases of tracheal prick during IJV cannulation diagnosed according to sudden leak in the endotracheal tube buffet have been reported. [7]

Our patient is the first described to have massive hemoptysis associated with a cervical hematoma and airway obstruction following IJV cannulation. Although the actual mechanism of hemoptysis cannot be established, it is possible that the needle created a fistulous tract between the IJV, carotid artery, and trachea. This laceration could have provided a way for the development of hemoptysis and a cervical hematoma leading to acute airway obstruction. Alternatively, hemoptysis may have been caused by means of lung puncture, as reported during transthoracic needle biopsy. However, this is unlikely as the patient did not disentangle a pneumothorax, and hemoptysis in needle biopsy is usually insignificant. [8]

The dramatic, unexpected occurrence of a cervical hematoma, airway obstruction, and massive hemoptysis during insertion of an IJV catheter emphasizes the potential for life-threatening complications during IJV cannulation.

(*1) From the Division of Critical Care Medicine, prepare for the table County Hospital, Chicago, and University of Health Sciences/The Chicago Medical academy North Chicago, IL.

REFERENCES

[1] English ICW, Frew RM Pigot JF Zaki M Percutaneous catheterization of the internal jugular vein. Anaesthesia 1969; 24:521-31

[2] Schwartz AJ, Jobes DR Greenhow DE Stephenson LW Ellison N Carotid artery small hole with internal jugular cannulation. Anesthesiology 1979; 51:160