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A rare case of internal jugular vein dissection following central venous catheterization
Hitesh Bansal1, Giulia Gambino2
1Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
Insights
A rare internal jugular venous dissection occurred during central venous catheterization before cardiac surgery. This complication is likely underreported but often self-limiting due to low venous pressure.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Critical Care Medicine
Background:
- Central venous catheterization (CVC) is a common medical procedure for drug administration, hemodynamic monitoring, and other interventions.
- CVC is frequently performed prior to cardiac surgery to establish vascular access.
- Potential complications, though rare, necessitate careful consideration and management.
Observation:
- A 66-year-old female patient developed an internal jugular venous dissection during CVC placement before cardiac surgery.
- Ultrasound visualization revealed the venous dissection when guidewire advancement failed.
- Successful cannulation was achieved on the contralateral side without further complications.
Findings:
- Venous dissection is an uncommon complication of central venous catheterization.
- The actual incidence of venous dissection may be higher than reported due to its often self-limiting nature.
- Low venous pressure typically allows for spontaneous resolution of venous dissections.
Implications:
- Management of venous dissection involves monitoring for spontaneous resolution.
- Surgical intervention may be required if the dissection continues to expand.
- Awareness of this rare complication is crucial for procedural safety in central venous catheterization.
Abstract:
Background: Central venous catheterization (CVC) is an important and common procedure performed for the purpose of drug administration, hemodynamic monitoring, emergency venous access, and extracorporeal intervention. We report a rare case of CVC prior to cardiac surgery, complicated by internal jugular venous dissection. Case presentation: A 66-year-old female was undergoing central venous catheterization prior to cardiac surgery. During the procedure the guidewire could not be proceeded at which point an ultrasound was used to visualize the internal jugular vein, where a venous dissection was noted. Cannulation was, therefore, undertaken on the contralateral side, which was done uneventfully. Conclusion: Venous dissection is a rare complication of CVC, however the incidence is likely higher than the frequency of reporting suggests. Given the low pressures in the venous system the dissection will likely be self-limiting and can be monitored for complication. However, should continue expansion occur, surgery would be necessary.
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