[Compressive hematoma complicating percutaneous catheterization of the axillary vein]

A 41-year-old woman was admitted in the intensive care unit with ruptured oesophageal varices. She had already had two similar events, six and four months previously. She had a haemoglobin concentration of 56 g.l-1, 20% prothrombin, 228 s activated cephalin time for a control time of 60 s, 0.9 g.l-1 of fibrinogen and a platelet count of 53 G.l-1. Because of the poor condition of her peripheral veins, it was decided to insert a central venous catheter. The axillary vein was chosen because of the coagulopathy. The axillary artery was accidentally punctured during the second attempt. Despite manual compression for 15 min, a small haematoma arose. The catheter was inserted in the right internal jugular vein. At the same time, a very large oedema of the left arm was noticed. The axillary haematoma had spread to the breast and lumbar fossa. The humeral and radial pulse amplitudes were decreased, and the patient complained of paraesthesiae. At phlebography, a vast haematoma was seen to compress the axillary vein. The patient's condition rapidly worsened, and she died 19 hours after admission with a probable cerebral haemorrhage. Although complications of axillary venous catheterization are rare, this case demonstrates that, in patient with very abnormal coagulation tests, central venous access should be obtained via a peripheral vein.