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Repeated neurological complications during dialysis - a case for echo?
Danja S Groves1, Ulf Harding, Christian Lanckohr
1Department of Anesthesiology and Intensive Care Medicine, University of Muenster, Muenster, Germany; Departments of Anesthesiology, University of Virginia, Charlottesville, Virginia.
Echocardiography (Mount Kisco, N.Y.)
|January 4, 2014
Summary
A misplaced dialysis catheter in the aorta caused serious complications, including seizures and hemiparesis. Ultrasound guidance is crucial for safe intravascular catheter placement.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- A 65-year-old woman with renal failure and right heart failure required renal replacement therapy.
- Dialysis catheter placement via the left jugular vein was complicated by altered dialysis flows and neurological deficits.
Observation:
- Transesophageal echocardiography revealed the dialysis catheter tip within the ascending aorta.
- Neck vessel imaging confirmed primary catheter placement in the left common carotid artery.
Findings:
- Malposition of the dialysis catheter in the carotid artery led to aortic entry.
- Complications included impaired consciousness, seizures, and left-sided hemiparesis.
Implications:
- This case highlights the critical importance of ultrasound guidance during intravascular catheter insertion.
- Proper technique is essential to prevent life-threatening misplacement and associated neurological sequelae.
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