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Paediatric cardiac arrest during Hickman line insertion
Paediatric Anaesthesia
|January 1, 1997
Summary
A child experienced cardiac arrest due to a misplaced central venous catheter (CVC) in a persistent left superior vena cava (LSVC). Prompt diagnosis via echocardiography led to a full recovery, highlighting CVC placement risks.
Area of Science:
- Cardiology
- Pediatric Anesthesiology
- Medical Imaging
Background:
- Central venous catheters (CVCs) are crucial for administering medications and monitoring in pediatric patients.
- An errant placement of a CVC can lead to serious complications, including cardiac events.
- Persistent left superior vena cava (LSVC) is a rare congenital anomaly where the left superior vena cava drains into the coronary sinus.
Observation:
- A four-year-old girl suffered cardiac arrest during anesthesia due to complete heart block.
- The event occurred during the flushing of a long-term central venous catheter.
- The catheter was found to be incorrectly placed within a persistent left superior vena cava (LSVC) draining into the coronary sinus.
Findings:
- The misplacement of the CVC into the LSVC directly connected to the coronary sinus was the cause of the cardiac arrest.
- Diagnosis was initially suspected via chest X-ray.
- Two-dimensional echocardiography confirmed the LSVC and the catheter's aberrant position.
Implications:
- This case underscores the critical importance of verifying central venous catheter placement, especially in pediatric patients with potential congenital anomalies.
- Awareness of LSVC and its potential complications during CVC insertion is vital for anesthesiologists and interventional cardiologists.
- Accurate and timely diagnosis using imaging modalities like echocardiography is essential for managing such critical events and ensuring patient recovery.