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Ultrasound-Enabled Noninvasive Management of Inadvertent Carotid Cannulation

Stacy Libricz1, Ayan Sen2, Victor Davila3

  • 1Department of Critical Care, Mayo Clinic Arizona, Phoenix, Arizona.

WMJ : Official Publication of the State Medical Society of Wisconsin
|September 8, 2018
PubMed

Insights

Accidental carotid artery cannulation during central venous catheter (CVC) placement can occur. An ultrasound-guided pull-and-pressure technique offers a safe alternative to surgical repair for CVC removal, preventing complications.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Critical Care Medicine

Background:

  • Central venous catheter (CVC) placement is a common procedure.
  • Accidental cannulation of the carotid artery during CVC insertion can necessitate surgical intervention.
  • Real-time ultrasound guidance is increasingly used in vascular access procedures.

Observation:

  • Two cases of inadvertent CVC placement into the left common carotid artery are presented.
  • The CVCs were successfully removed using a pull-and-pressure technique under real-time ultrasound guidance.
  • No immediate or delayed complications, such as fistula, hematoma, or cerebral infarct, were observed.

Findings:

  • The ultrasound-guided pull-and-pressure technique facilitated safe removal of the CVC from the carotid artery.
  • This minimally invasive approach avoided the need for operative repair in both patients.
  • Follow-up imaging confirmed the absence of vascular complications.

Implications:

  • Real-time ultrasound guidance is a feasible and safe adjunct for managing accidental carotid artery cannulation during CVC placement.
  • This technique may serve as an alternative to surgical repair, particularly in critically ill patients.
  • Minimizing operative interventions can reduce patient morbidity and healthcare costs.
Abstract

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