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Haemorrhagic Shock in a Pregnant Patient and the Unsuspicious Subclavian Catheter
André Silva1, Diogo Rebolo1, Pedro Santos1
1Intensive Care Department, Hospital Sousa Martins, Guarda, Portugal.
Introduction:
Central venous catheterisation (CVC) is a commonly performed procedure in clinical practice. Although usually safe, complications can arise such inadvertent vascular lesion. This report is of a case of left brachiocephalic vascular lesion due to a subclavian catheter, thus raising awareness about this potential complication, which is not always immediately recognised.
Case Report:
We report the case of a 31-year-old healthy woman, 42 weeks pregnant, who presented with complications during an elective caesarean section. The patient experienced haemorrhagic shock due to the incomplete rupture of the left ovarian pedicle, further complicated by the accidental lesion of the left brachiocephalic vein caused by the tip of a right subclavian catheter, aggravated by the late discovery only after extubation. This case highlights the importance of patient selection, proper technique and the careful monitoring pre- and post-procedure.
Conclusion:
Brachiocephalic vein lesions arising from CVC insertions are rare but significant complications that require timely recognition and intervention.
Learning Points:
Although uncommon, vascular lesions from central venous catheter insertion can occur so post-procedural monitoring and follow-up are very important.Computed tomography angiography is a useful diagnostic tool.Many vascular injuries related to central venous catheter insertion can have a delayed presentation.
