Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 7  |  Issue : 4  |  Page : 444

Letter to the editor- step-by-step guide to averting and managing a central line insertion misadventure


Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

Date of Submission21-Jul-2019
Date of Acceptance23-Jul-2020
Date of Web Publication24-Dec-2020

Correspondence Address:
Srineil Vuthaluru
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_103_20

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How to cite this article:
Vuthaluru S, Krishna A. Letter to the editor- step-by-step guide to averting and managing a central line insertion misadventure. Indian J Vasc Endovasc Surg 2020;7:444

How to cite this URL:
Vuthaluru S, Krishna A. Letter to the editor- step-by-step guide to averting and managing a central line insertion misadventure. Indian J Vasc Endovasc Surg [serial online] 2020 [cited 2021 Jan 28];7:444. Available from: https://www.indjvascsurg.org/text.asp?2020/7/4/444/304622



In this publication, the authors have brought to light important complications which can be encountered while attempting to gain central venous access. They have aptly discussed the complications with illustrations from a series of cases. Inadvertent arterial puncture is a common complication following the placement of a central venous line. We would like to congratulate the authors for the excellent study. However, we would like to point out certain points which need attention. The authors rightly emphasized the need for mandatory use of ultrasound for vessel puncture and deployment of the catheter under fluoroscopic guidance. Following this protocol, recently published ASA guidelines in 2020 reported incidence of inadvertent arterial puncture to be <3.7%.[1],[2] Images illustrating Cases 1 and 2 [Figures 1 and 7] seem to have been captured as screenshots from computer console wherein patients' identity and other information can be easily deciphered which might be considered as “breach of confidentiality.” Acquiring pictures in JPF or IF format could have avoided this problem and also provided better resolution pictures. In addition, the image in [Figure 4] (case 2) seems to suggest that the tip of the catheter is in a tributary of external iliac rather than piercing the external iliac vein that can explain “ability to draw blood from the catheter and at the same time cause high returning pressure when connected to a dialysis machine.” A representative image of “clear-cut” extravasation of contrast would have illustrated their viewpoint of inadvertent puncture of external iliac vein better. Finally, the authors rightly emphasized the importance of the following basic principles while gaining central venous endorsed by the ASA 2020 guidelines.[1] They have also provided a list of “do's and don'ts,” if there are inadvertent mishaps. However, the authors mention that if the patient complains of severe back or chest pain, then it is likely that the catheter is in extradural space (page 162, para 11). We are unable to understand how a central venous access catheter can reach the extradural space and would like clarification from the authors to explain this.

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Practice Guidelines for Central Venous Access 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology 2020;132:8-43.  Back to cited text no. 1
    
2.
Nicholson T, Ettles D, Robinson G. Managing inadvertent arterial catheterization during central venous access procedures. Cardiovasc Intervent Radiol 2004;27:21-5.  Back to cited text no. 2
    




 

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