| Popis: |
A large number of central venous catheters (CVC) are placed each year in the emergency room, operation theatre and critical care units. Although rarely associated with life threatening complications, femoral CVC is known to have the highest incidence of mechanical complications. The femoral veins are frequently preferred when other access sites are exhausted or there is increased risk for complications such as with emergency access, coagulopathy, and in the uncooperative patient .Femoral line placement confirmation is not routine practice. We present our case 59 years old male, Known case of Diabetes ,liver cirrhosis and portal hypertension presented to Accident and Emergency with repeated hematemesis and melena 3 times. On arrival to hospital patient was drowsy and hallucinating. Two large bore venous cannula were inserted and due to his hemodynamic instability requiring vasopressor support, Femoral venous catheter was inserted because of his deranged coagulation profile, with good blood flow and backflow , venous blood gases ( VBG) for placement confirmation was done. Patient was admitted for urgent upper GI endoscopy which revealed esophageal varix where bands were applied and with suspicious of Gut perforation. Urgent Computed Tomography ( CT ) of the abdomen was done . accidental radiological finding that the femoral line appeared to be curled posteriorly on itself. Patient was admitted to ICU where the malpositioned femoral line was removed and new central line was inserted confirmed position by the ultrasound and x-ray. Our conclusion from this case that even with functioning femoral lines confirmation by VBG alone is not enough and we recommend use of ultrasound not even during insertion but after placement for confirmation. |
