INADVERTENT CAROTID ARTERY CANNULATION: A CASE REPORT ON PATIENT OUTCOMES IN CENTRAL VENOUS ACCESS PROCEDURES
Creators: name: Lakshmanarajan
name: Deepika
name: Shanmugapriya V
name: Yuvaraj M
name: Karthikeyan D
Publisher: name: Zenodo
Year: 2024
Subjects: Inadvertent Carotid Artery Catheterization, Central Venous Access, Patient Outcomes, Tetralogy of Fallot, Neurological Complications.

description: Abstract

Inadvertent carotid artery cannulation is a life threatening complication occurs during central venous catheterization (CVC) procedure which leads to serious patient outcomes. The carotid artery lies in close proximity to the internal jugular vein, which is a common site for CVC insertion, increasing the risk of inadvertent arterial puncture. This case report presents a detailed examination of a 51-year-old male with a history of congenital heart disease (CHD), specifically tetralogy of Fallot (TOF), who experienced inadvertent carotid artery cannulation during a routinxe CVC procedure. The patient presented with worsening exertional intolerance, New York Heart Association (NYHA) class II symptoms, intermittent pedal edema, and anorexia. Clinical examination revealed grade III clubbing, cyanosis, elevated jugular venous pressure (JVP), and oxygen saturation (SpO2) of 82%. Preoperative coronary angiography (CAG) showed normal coronary arteries and the possibility of a conal artery crossing the right ventricular outflow tract (RVOT). Transthoracic echocardiography (ECHO) confirmed TOF with a large conoventricular ventricular septal defect (VSD) and severe infundibular annular pulmonary stenosis. The patient was scheduled for intracardiac repair (ICR) using a homograft to the main pulmonary artery (MPA). During the procedure, an internal jugular vein (IJL) puncture was performed using a conventional landmark technique. Following the insertion of a central venous catheter (CVC), the patient's blood pressure dropped, and the central venous pressure (CVP) monitor displayed an arterial waveform, indicating inadvertent carotid artery cannulation. The surgery was deferred, and the CVC was promptly removed with subsequent compression. Despite being extubated later that evening, the patient exhibited persistent drowsiness, hypoventilation, and mild left-sided weakness. Imaging revealed chronic lacunar infarcts and multiple acute infarcts in various brain regions. This case underscores the importance of immediate recognition and management of inadvertent carotid artery cannulation to prevent severe complications. The patient's neurological symptoms, although transient, highlight the potential for serious outcomes associated with inadvertent carotid artery cannulation. Continuous neurological monitoring and conservative management were crucial in this case, leading to an uneventful postoperative period despite the initial complications. The findings from this case contribute to the existing body of knowledge by emphasizing the critical need for meticulous technique during CVC procedures and the prompt identification of inadvertent carotid artery cannulation. The case also suggests that non-surgical management can be effective in certain scenarios, reducing the risk of further complications. Future research should focus on developing standardized protocols for the prevention, early detection, and management of inadvertent carotid artery cannulation to improve patient outcomes.