We report a case of an infusion of intra-aortic propofol after the missed inadvertent placement of a centra venous catheter into the right common carotid artery. Radiological imaging revealed bilateral ischaemic infarct in the posterior fossa and right cerebral artery territories consistent with an embolic source. The potential cause of the neurological injuries sustained in this case are explored. Discussion focuses on the sequelae, managemen and prevention of an iatrogenic carotid artery injury from a central venous catheter insertion. Finally, we propose an algorithm for management of iatrogenic carotid artery cannulation.
TroianosC.A., HartmanG.S., GlasK.E., SkubasN.J., EberhardtR.T., WalkerJ.D.Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr2011; 24: 1291–1318.
2.
HindD., CalvertN., McWilliamsR., DavidsonA., PaisleyS., BeverleyC.Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ2003; 327: 361.
3.
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.
4.
DenysB.G., UretskyB.F.Anatomical variations of internal jugular vein location: impact on central venous access. Crit Care Med1991; 19: 1516–1519.
5.
RandolphA.G., CookD.J., GonzalesC.A., PribbleC.G.Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med1996; 24: 2053–2058.
6.
Guidance on the use of ultrasound locating devices for placing central venous catheters. Natl Inst Heal Care Excell.2000. Pp. 1–31.
7.
Central Line Insertion and Maintenance Guideline. ANZICS.2012; 1–20.
8.
GuilbertM.C., ElkouriS., BraccoD., CorriveauM.M., BeaudoinN., DuboisM.J.Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg2008; 48: 918–925.
9.
Momjian-MayorI., BaronJ.C.The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke2005; 36: 567–577.
10.
ManglaR., KolarB., AlmastJ., EkholmS.E.Border zone infarcts: pathophysiologic and imaging characteristics. Radiographics2011; 31: 1201–1214.
11.
Abi-JaoudehN., TurbaU.C., ArslanB., HagspielK.D., AngleJ.F., SchenkW.G.Management of subclavian arterial injuries following inadvertent arterial puncture during central venous catheter placement. J Vasc Interv Radiol2009; 20: 396–402.
BrimacombeJ., GandiniD., BashfordL.Transient decrease in arm blood flow following accidental intra-arterial injection of propofol into the left brachial artery. Anaesth Intensive Care1994; 22: 291–292.
14.
ChongM., DavisT.P.Accidental intra-arterial injection of propofol. Anaesthesia1987; 42: 781.
15.
DugganM., BraudeB.M.Accidental intra-arterial injection through an ‘intravenous’ cannula on the dorsum of the hand. Paediatr Anaesth2004; 14: 611–612.
16.
HatchP.Intra-arterial injection of propofol. Anaesth Intensive Care1993; 21: 481–482.
17.
HolleyH.S., CuthrellL.Intraarterial injection of propofol. Anesthesiology1990; 73: 183–184.
18.
MacPhersonR.D., RasiahR.L., McLeodL.J.Intraarterial propo-fol is not directly toxic to vascular endothelium. Anesthesiology1992; 76: 967–971.
19.
MitaniSi, IshiyamaT., MatsukawaT.Inadvertent intraarterial injection of propofol in a patient under general anesthesia. J Anesth2009; 23: 307.
20.
MurphyE.J.Intra-arterial injection of metoclopramide, mida-zolam, propofol and pethidine. Anaesth Intensive Care2002; 30: 367–369.
MarikP.E.Propofol: therapeutic indications and side-effects. Curr Pharm Des2004; 10: 3639–3649.
26.
MirtalloJ.M., DastaJ.F., KleinschmidtK.C., VaronJ.State of the art review: Intravenous fat emulsions: Current applications, safety profile, and clinical implications. Ann Pharmacother2010; 44: 688–700.
27.
LorchirachoonkulT., TiL.K., ManoharaS., LyeS.T., TanS.A., ShenL.Anatomical variations of the internal jugular vein: implications for successful cannulation and risk of carotid artery puncture. Singapore Med J2012; 53: 325–328.
28.
PhelanM., HagertyD.The oblique view: an alternative approach for ultrasound-guided central line placement. J Emerg Med2009; 37: 403–408.
29.
LakeK., BarkerC., JeffersonP., BallD.R.Monitoring central venous pressure: proximal or distal lumen?Anaesthesia2011; 66: 318–319.