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LETTER TO THE EDITOR
Year : 2012  |  Volume : 2  |  Issue : 3  |  Page : 189

Extrapleural hematoma secondary to subclavian vein canalization


Department of Intensive Care, Universitary Hospital Insular in Gran Canaria, Las Palmas of Gran Canaria, Spain

Date of Web Publication12-Sep-2012

Correspondence Address:
Luciano Santana-Cabrera
Marítime Avenue of the South, Las Palmas of Gran Canaria, Canary Islands-35016
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.100938

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How to cite this article:
Santana-Cabrera L, Martín-García JA, Villanueva-Ortiz A, Sánchez-Palacios M. Extrapleural hematoma secondary to subclavian vein canalization. Int J Crit Illn Inj Sci 2012;2:189

How to cite this URL:
Santana-Cabrera L, Martín-García JA, Villanueva-Ortiz A, Sánchez-Palacios M. Extrapleural hematoma secondary to subclavian vein canalization. Int J Crit Illn Inj Sci [serial online] 2012 [cited 2019 Oct 23];2:189. Available from: http://www.ijciis.org/text.asp?2012/2/3/189/100938

Sir,

Placement of central venous catheter is essential in the management of critically ill patient. Central venous access, in which a large bore catheter is routed through a vein in the neck, upper chest or femoral area, is needed to give drugs that cannot be given by mouth or via a conventional cannula in the arm.

Subclavian vein catheterization can result in serious vascular injury leading to hemothorax in 4.4%. [1] We report a 62-year-old female who developed unexplained respiratory failure and refractory shock on the completion of percutaneous placement of a catheter in the right subclavian vein. Chest radiography revealed a collection in the right upper hemithorax. A right thoracostomy tube is placed but does not drain pleural blood [Figure 1]. Chest CT is performed without and after administration of intravenous contrast and revealed in the right hemithorax, extrapleural location, collection of 19×8×9 cm, heterogeneous with regard to bleeding, probably at the expense of subclavian vein as the subclavian artery is patent and without signs of injury, pleural drainage tube in lung apex. Hemodynamic stability was restored after surgical repair of the injured vessel, aggressive volume resuscitation and inotropic/vasopressor treatment.
Figure 1: Chest radiography revealed a collection in the right upper hemithorax but a right thoracostomy tube but does not drain pleural blood

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Cannulation subclavia vein can be related with many complications. Hemothorax resulting from perforation of a great vessel is an uncommon but life-threatening complication which may occur during insertion of a central venous catheter. [2] Surgical revision is indicated immediately if a major blood loss or a circulation insufficiency occur. Surgical treatment of bleeding in cupola of pleural cavity is due to its bad accessability and conventional surgical methods are not sufficient. [3]

Some authors have reported that ultrasound-guided cannulation of the subclavian vein in critical patients is superior to the landmark method and should be the method of choice. [1],[4],[5]

It is very important to make a prompt diagnosis of potentially fatal complications, such as perforation of great central vein due to inadvertent cannulation.

 
   References Top

1.Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Karabinis A, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study. Crit Care Med 2011;39:1607-12.  Back to cited text no. 1
[PUBMED]    
2.Tawfic QA, Bhakta P, Mohammed AK, Sharma J. Subclavian vein injury and massive hemothorax requiring thoracotomy following insertion of tunneled dialysis catheter-a case report and review of literature. Middle East J Anesthesiol 2010;20:861-4.  Back to cited text no. 2
[PUBMED]    
3.Cerný M, Havlícek K, Sákra L, Flasar J. Massive hemothorax following canylation of the subcalvian vein--a case review. Rozhl Chir 2008;87:376-9.  Back to cited text no. 3
    
4.Wang CY, Liu K, Chia YY, Chen CH. Bedside ultrasonic detection of massive hemothorax due to superior vena cava perforation after hemodialysis catheter insertion. Acta Anaesthesiol Taiwan 2009;47:95-8.  Back to cited text no. 4
    
5.Oguzkurt L, Tercan F, Kara G, Torun D, Kizilkilic O, Yildirim T. US-guided placement of temporary internal jugular vein catheters: Immediate technical success and complications in normal and high-risk patients. Eur J Radiol 2005;55:125-9.  Back to cited text no. 5
    


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