2018 FSA Posters

P021: CEREBROVASCULAR ACCIDENT AFTER INTERNAL JUGULAR CATHETERIZATION: CAROTID INJURY COMPLICATIONS AND MANAGEMENT
Marco Castillo, MD, Federico Perez Quirante, MD, Enrique Huertas, Santiago Luis, MD; Cleveland Clinic Florida

Central venous catheter (CVC) placement is a common procedure. Unintended arterial cannulation is an infrequent but dangerous complication. There is no consensus about how it should be managed. A case report of a stroke after an arterial cannulation is made along with a review of the literature to discuss the best management.

A 72 year old female, obese, smoker patient with a history of hypertension and hyperlipidemia, goes to the operating room for a total hip replacement of an infected hip arthroplasty. After induction, catheterization of a 8.5 Fr lumen on the right internal jugular was attempted, arterial pressure was noted.

US confirmed intra-arterial catheter. Hemostasis was achieved with manual compression. The surgery proceeded.

The morning after, the patient presented with left upper extremity and facial weakness and dysarthria.

An brain MRI demonstrated acute infarct in the distribution of the right middle cerebral artery.

US confirmed ipsilateral carotid atherosclerosis. The patient symptoms improved after twenty four hours with no other complications.

Complications occurs in less than 15%. The treatments available for these types of injuries are: Withdrawal of the needle with manual pressure for 10 minutes, open exploration with direct arterial repair and percutaneous treatment.

Manual pressure is proven to be an easy and cost-effective, nonetheless, the risk of complications are higher, this is especially true with large catheters. When these events happen in the operating room, the need to stop the ongoing surgery and have vascular surgery evaluation should be considered to prevent any more harm; it should be based in the event of an elective surgery and  with large catheters. The need for anticoagulation should be weighted as well, and immediate carotid ultrasound with close neurological monitoring should be guaranteed.