Deformed introducer needle during subclavian vein catheterization – escape from catastrophic sequel

摘要

To The Editor: Subclavian vein (SCV) catheterization is an established maneuver to obtain venous access, but it may result in life-threatening complications such as pneumothorax and intrathoracic haemorrhage. 1 We report a case of deformed introducer needle during SCV catheterization with concerns for possible catastrophic complications. A 43-yr-old, 55 kg female was scheduled for excision of left vestibular schwannoma. In the operating room, routine monitoring gadgets were connected, and anaesthesia was induced with a standard technique. Placement of central venous catheter (CVC) via right subclavian vein was planned, in view of nature of surgery and anticipated blood loss. Modified Seldinger’s technique was followed for the placement of CVC. An 18G introducer needle (Vygon BP 7F, Multicath) was inserted just below the midpoint of clavicle, and directed towards supra sternal notch. In first attempt, the needle tip was struck the clavicle, and there was difficulty in negotiating it, further. The needle was withdrawn, and another attempt was made to access the vein. There was difficulty in inserting the needle through the skin. On close view, beveled tip of needle was observed to be bent (Fig.1).