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LETTERS TO EDITOR
Year : 2023 | Volume
: 24
| Issue : 1 | Page : 84-85
Curious case of central venous catheter leak
Manav Sharma1, Sharmishtha Pathak2
1 Department of Forensic Medicine and Toxicology, ESIC Medical College and Hospital, Faridabad, Haryana, India
2 Department of Anaesthesiology, Pain Medicine and Critical Care, JPNATC, AIIMS, New Delhi, India
Correspondence Address:
Dr. Sharmishtha Pathak
Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, Delhi
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/TheIAForum.TheIAForum_7_23
How to cite this article:Sir,
We would like to report a case of inadequate fluid management of the patient due to a leakage in the proximal port of the central venous catheter. A 36-year-old male who suffered extensive pelvic injuries following a road traffic accident was brought to the emergency department of our trauma center and was immediately transfused with packed red blood cell, fresh frozen plasma, and platelets (4:4:4). The patient did not respond to the above management and hence was shifted to operation theater (OT) immediately for exploration due to his nonresponder status. Intraoperatively, the patient required vasopressor support, which was initiated through the broad gauge peripheral venous access (16G). Since the vasopressor requirement was increasing, a central venous line placement was desired. Cervical spine injury could not be ruled out before shifting to OT; hence, we decided against the removal of the cervical collar and placed a subclavian line. Once the line was placed, we shifted the vasopressors to the central line. The patient was stabilized and was shifted to the intensive care unit (ICU) after internal iliac artery ligation. Once the requirement of vasopressor decreased, the patient was again taken to OT for the removal of abdominal packs and the creation of stoma. Intraoperatively, once the packs were removed, the patient started bleeding and required fluid resuscitation, which was being provided through the central line. However, even after starting fluids the patient was not responding and hence, we started looking for all the possible causes and found that the fluid was leaking under the sheets next to the patient. On close examination, we found that the proximal port was broken [Figure 1] and the fluid had been partially leaking from there, thus adequate resuscitation was not taking place. Once this port was blocked and fluidly connected to the medial port, the patient stabilized hemodynamically and the vasopressor requirement decreased. The remainder of the surgery was uneventful, and the patient was shifted to ICU for further monitoring and management.
Figure 1: Injection of saline leaking out as a stream as shown by the red arrowVarious complications have been reported with the use of central venous catheters. These complications range from those related to catheter insertion, immediate access related as well as long-term complications.[1] Most observed complications include bleeding, arterial puncture, arrhythmia, air embolism, catheter malposition, and pneumothorax or hemothorax.[2] Catheter-related complications include catheter malfunction and migration.[3] Mechanical issues with the catheter are reported rarely. In our case, there was a mechanical issue with the catheter which resulted in leakage of fluid. This compels us to realize the importance of checking and cross-checking the intravenous fluid connections, again and again, to avoid such defective devices from affecting patient care. This case highlights the importance of continuous monitoring of the patient and lines intraoperatively, thus helping in catching any defects early and providing timely correction.[4],[5] With increased production of medical devices, there is a high chance of deterioration in quality. Although the products pass various quality checks, there can be errors in one or two of the thousands manufactured and we may end up with that one faulty product, thus reiterating the need for a vigilant anesthesiologist.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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