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Subclavian line infiltration causing neck compartment syndrome and bradycardic arrest: A case report
Taylor B Bucyk1, Caitlin R Collins2, Jeffrey T Macuja1
1University of California San Francisco, Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
Insights
Central venous catheter (CVC) infiltration can be life-threatening. Prompt recognition and intervention are crucial, especially during rapid fluid resuscitation, to prevent severe complications like cardiac arrest.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Vascular Access
Background:
- Central venous catheters (CVCs) are vital for resuscitation but carry risks.
- Malpositioned CVCs can lead to serious, unrecognized infiltrations into critical anatomical spaces.
Observation:
- A 30-year-old male with gunshot wounds developed bradycardic arrest due to a left subclavian CVC infiltrating the neck.
- The infiltration compressed the carotid sinus, leading to cardiac arrest.
Findings:
- Successful resuscitation was achieved through epinephrine, cardiac massage, and emergency neck exploration with cervical fasciotomy.
- The case underscores the risk of CVC infiltration during high-intensity resuscitation, particularly with rapid infusion devices.
Implications:
- Frequent reassessment of CVC placement and function is critical in emergent settings.
- Clinicians should be aware that rapid infusion devices may not reliably detect interstitial CVC placement, risking significant harm.
Abstract:
Unrecognized central venous catheter (CVC) infiltration is an uncommon but potentially life-threatening complication. For instance, a malpositioned subclavian line can infuse into the mediastinum, pleural cavity, or interstitial space of the neck. We present the case of a 30-year-old male with gunshot wounds to the right chest, resuscitated with an initially functional left subclavian CVC, which later infiltrated into the neck causing compression of the carotid sinus and consequent bradycardic arrest. Return of spontaneous circulation (ROSC) was achieved following intravenous epinephrine, cardiac massage, and emergency neck exploration and cervical fasciotomy. Our case highlights the importance of frequent reassessment of lines, especially those placed during fast-paced, high-intensity clinical situations. We recommend being mindful when using rapid transfusion devices as an interstitial catheter may not mount enough back pressure to trigger the system's alarm before significant tissue damage or compartment syndrome occurs.
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