Airway Obstruction due to a Pre-vertebral Haematoma following Difficult Central Line Insertion – Implications for Ultrasound Guidance and Review of the Literature
Free accessResearch articleFirst published online March, 2009
Airway Obstruction due to a Pre-vertebral Haematoma following Difficult Central Line Insertion – Implications for Ultrasound Guidance and Review of the Literature
We describe a case of airway obstruction secondary to a large pre-vertebral cervico-mediastinal haematoma following failed attempts at insertion of an internal jugular central venous line. The need for a high index of suspicion to diagnose this injury and early aggressive intervention to manage it are outlined. The role of ultrasound guidance in preventing such a complication is reviewed, as well as other possible mechanisms of haematoma development.
SilvaF.S.Neck haematoma and airway obstruction in a patient with goitre: complication of internal jugular vein cannulation. Acta Anaesthesiol Scand2003; 47: 626–629.
3.
LauH.P., LinT.Y., LeeY.W., LiouW.H., TsaiS.K.Delayed airway obstruction secondary to inadvertent arterial puncture during percutaneous central venous cannulation. Acta Anaesthesiol Sin2001; 39: 93–96.
4.
RiderM.A., ChellJ.Iatrogenic haematoma causing airway obstruction in a burned patient. Burns1994; 20: 260–261.
5.
JeganathV., McElwaineJ.G., StewardP.Ruptured superior thyroid artery from central vein cannulation: treatment by coil embolization. Br J Anaesth2001; 87: 302–305.
6.
LoW.K., ChongJ.Neck haematoma and airway obstruction in a preeclamptic patient: a complication of internal jugular vein cannulation. Anaesth Intensive Care1997; 25: 423–425.
7.
FisherN.C., MutimerD.J.Central venous cannulation in patients with liver disease and coagulopathy – a prospective audit. Intensive Care Med1999; 25: 481–485.
8.
MumtazH., WilliamsV., Hauer-JensenM., RoweM., Henry-TillmanR.S., HeatonK.Central venous catheter placement in patients with disorders of hemostasis. Am J Surg2000; 180: 503–505.
9.
McGeeD.C., GouldM.K.Preventing complications of central venous catheterization. N Engl J Med2003; 348: 1123–1133.
10.
MazzonD., ZanattaP., CurtoloS., BernardiV., BoscoE.Upper airway obstruction by retropharyngeal haematoma after cervical spine trauma: report of a case treated with percutaneous dilational tracheostomy. J Neurosurg Anesthesiol1998; 10: 237–240.
11.
ShawC.B., BawaR., SniderG., WaxM.K.Traumatic retropharyngeal hematoma: a case report. Otolaryngol Head Neck Surg1995; 113: 485–488.
12.
TenofskyP.L., PorterS.W., ShawJ.W.Fatal airway compromise due to retropharyngeal hematoma after airbag deployment. Am Surg2000; 66: 692–694.
KetteF., MergoniP., GirardisM., SabbadiniD., ZauliM., SussiL.Delayed upper airway obstruction following a retropharyngeal hematoma after minor head trauma. Eur J Emerg Med2000; 7: 301–303.
Chiti-BatelliS., VazF., ComanS.Traumatic retropharyngeal haematoma in an anticoagulated patient: Case report and proposal for a clinical protocol. Acta Otolaryngol2005; 125: 443–445.
BapatV.N., BrownK., NakasA., ShabboF.Retropharyngeal haematoma – a rare complication of anticoagulant therapy. Eur J Cardiothorac Surg2002; 21: 117–118.
19.
SinertR., ScaleaT.Retropharyngeal and bowel haematomas in an anticoagulated patient. Acad Emerg Med1994; 1: 67–72.
20.
WilsonM., HarrisonK.Severe post operative haemorrhage and airway obstruction following high dose enoxaparin. Med J Aust2001; 175: 167–168.
21.
ChinK.W., SercarzJ.A., WangM.B., AndrewsR.Spontaneous cervical haemorrhage with near complete airway obstruction. Head Neck1998; 20: 350–353.
22.
MillerR., CollisonP., GoudaH.E.Spontaneous retropharyngeal hemorrhage causing airway obstruction: a case report with a review of the literature. S D Med2006; 59: 295–297, 299.
23.
SemmondsA.K., DohertyS.Prevertebral haematoma after thrombolysis: an unusual cause of airway obstruction. Emerg Med (Fremantle)2001; 13: 251–254.
24.
DraperM.R., SandhuG., FroshA., ClarkeP.M.Retropharyngeal haematoma causing acute airway obstruction – first presentation of metastatic carcinoma. J Laryngol Otol1999; 113: 258–259.
25.
KroonC., ten HoveW.R., de BoerA., KroonJ.M., van der PolJ.M., Harthoorn-LasthuizenE.J.Highly variable anticoagulant response after subcutaneous administration of high-dose (12,500 IU) heparin in patients with myocardial infarction and healthy volunteers. Circulation1992; 86: 1370–1375.
26.
LeonardiM.J., McGoryM.L., KoC.Y.The rate of bleeding complications after pharmacologic deep venous thrombosis prophylaxis. Arch Surg2006; 141: 790–799.
27.
National Institute for Clinical Excellence: Guidance on the use of ultrasound locating devices for central venous catheters (NICE technology appraisal, No. 49)London, United Kingdom; 2002.
28.
BaileyP.L., WhitakerE.E., PalmerL.S., GlanceL.G.The accuracy of the central landmark used for central venous catheterization of the internal jugular vein. Anesth Analg2006; 102: 1327–1332.
29.
KarakitsosD., LabropoulosN., De GrootE., PatrianakosA.P., KouraklisG., PoularasJ.Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care2006; 10: R162.
30.
HindD., CalvertN., McWilliamsR., DavidsonA., PaisleyS., BeverleyC.Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ2003; 327: 361–368.
31.
MillingT.J.Jr., RoseJ., BriggsW.M., BirkhahnR., GaetaT.J., BoveJ.J.Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med2005; 33: 1764–1769.
32.
LeungJ., DuffyM., FinckhA.Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med2006; 48: 540–547.
33.
CalvertN., HindD., McWilliamsR., DavidsonA., BeverleyC.A., ThomasS.M.Ultrasound for central venous cannulation: economic evaulation of cost-effectiveness. Anaesthesia2004; 59: 1116–1120.
34.
GirardT.D., SchectmanJ.M.Ultrasound guidance during central venous catheterization: A survery of use by house staff physicians. J Crit Care2005; 20: 224–229.
35.
HigaK., HirataK., HirotaK., NitaharaK., ShonoS.Retropharyngeal hematoma after stellate ganglion block: analysis of 27 patients reported in the literature. Anesthesiology2006; 105: 1238–1245.
