Complication Of Venous Cut-Down: Migration Of Catheter That Remained In The Vein

摘要

The patient, who was followed up with a diagnosis of amyotrophic lateral sclerosis (ALS), was inserted a catheter with the approach of cephalic vein cut-down operation on left arm in order to enable parenteral nutrition and medical treatment. After the treatment, while the catheter was being pulled out, it was broken and a large part of it remained in the vessel. On the postero-anterior (PA) x-ray, the catheter was seen and it was taken out of the subclavian vein through venotomy in a surgical operation. The case was examined in accordance with the related literature. Introduction Central venous catheters are commonly used safely for the patients who require nutritional support, hemodynamic moniterazition, temporary transvenous cardiac pace-maker, plazmapharesis or hemodyalisis in intensive care unit (ICU) and in operating room. While they provide the replacement of fluid and blood products in ICU, they are also the common way to supply the patients with total parenteral nutrision therapy. Internal and external juguler vein, subclavian vein, femoral vein, and brakial vein are frequently used for venous cannulation. Seldinger is the tecnique commonly preferred in the placement of central venous catheters. Venous cut-down technique is only possible when the application of percutaneus insertion of the catheters cannot be made. In this study, a rare complication in a patient who underwent central catheterization with venous cut-down tecnique was examined within the lights of findings in the related literature. Case Report 32 years old male patient was brought to the emergency service with a severe complaint of serious dispnea and we detected that the patient had ALS diagnosis twelve years ago, he was bed-dependant and could not swallow for three years. After his hospitalization, central catheterization had been used with the cephalic vein cut-down tecnique on his left arm for the medical therapy. Just before the completion of the treatment of the patient, the catheter had broken off and the large part of it had remained in the venous system of him. As a result, we were required to consultate the patient (Picture 1).