|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 278-279
Accidental arterial chemoport catheter insertion
Pooja Bihani, Narendra Kaloria, Pradeep Bhatia, Sanjeev Kumar, Rishabh Jaju
Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
|Date of Submission||30-Apr-2019|
|Date of Acceptance||24-May-2019|
|Date of Web Publication||15-Jun-2020|
Dr. Pooja Bihani
Fellow Paediatric Anaesthesia, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bihani P, Kaloria N, Bhatia P, Kumar S, Jaju R. Accidental arterial chemoport catheter insertion. J Anaesthesiol Clin Pharmacol 2020;36:278-9
|How to cite this URL:|
Bihani P, Kaloria N, Bhatia P, Kumar S, Jaju R. Accidental arterial chemoport catheter insertion. J Anaesthesiol Clin Pharmacol [serial online] 2020 [cited 2020 Jul 2];36:278-9. Available from: http://www.joacp.org/text.asp?2020/36/2/278/286793
Implantable chemoports are being increasingly used in patients with cancer to facilitate long-term chemotherapy. The use of ultrasound to guide central venous access is one of the 11 recommended practices described by the Agency for Healthcare Research and Quality to improve the safety of procedures. A 5-year-old child with primitive neuroendocrine tumor of thorax was planned for chemotherapy, so a chemoport was inserted below the right clavicle under general anesthesia. The catheter was guided into the right internal jugular vein (IJV) with the aid of ultrasound. After a week when the port was opened for chemotherapy, a gush of bright red blood, probably arterial, came out. A volume-rendered computed tomography angiography showed that the catheter tip was traveling from IJV to carotid artery, reaching up to the aortic root through brachiocephalic trunk [Figure 1]. Sternotomy was done and the catheter tip was pulled back to IJV followed by vascular repair. The perioperative period was uneventful. A parental consent had been taken for possible publication of the case.
The incidence of accidental arterial cannulation has fallen down considerably with the use of ultrasound. In this case, the introducer needle placement in the IJV was confirmed with ultrasound. The possibility of guidewire puncturing the artery through IJV seems less likely due to its atraumatic J tip. The needle probably had punctured the carotid artery through IJV during the guidewire insertion, and subsequently, catheter was threaded over it. The aspiration of bright red colored blood during insertion was overlooked in our case due to high O2 concentration delivered under anesthesia. Ultrasound visualization of the guidewire prior to dilation and insertion of the catheter may prevent carotid cannulation, but in our case, the guidewire could not be tracked with ultrasound as the insertion point was just above the clavicle. The needle insertion point at the level of cricoid would have enabled the tracing of the guidewire with ultrasound.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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