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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 36  |  Issue : 2  |  Page : 278-279

Accidental arterial chemoport catheter insertion


Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Submission30-Apr-2019
Date of Acceptance24-May-2019
Date of Web Publication15-Jun-2020

Correspondence Address:
Dr. Pooja Bihani
Fellow Paediatric Anaesthesia, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_127_19

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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 4];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.[1] 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.
Figure 1: Misplaced chemoport catheter

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The incidence of accidental arterial cannulation has fallen down considerably with the use of ultrasound.[2] 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,[3] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agency for Healthcare Research and Quality. Making Health Care Safer: A Critical Analysis of Patient Safety Practices; 2001  Back to cited text no. 1
    
2.
Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig PL, Easley KA, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med 2009;37:1090-6.  Back to cited text no. 2
    
3.
Stone MB, Nagdev A, Murphy MC, Sisson CA. Ultrasound detection of guidewire position during central venous catheterization. Am J Emerg Med 2010;28:82-4.  Back to cited text no. 3
    


    Figures

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