Korean J Crit Care Med.  2016 Feb;31(1):63-67. 10.4266/kjccm.2016.31.1.63.

Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?

• Lee H
• Baek J
• Park S
• Jee D

• KMID: 2227616
• DOI: http://doi.org/10.4266/kjccm.2016.31.1.63

Abstract

A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.

Keyword

cardiopulmonary resuscitation; central venous catheters; pediatrics; pulmonary embolism

MeSH Terms

Anesthesia, General
Cardiopulmonary Resuscitation
Catheterization*
Catheters*
Central Venous Catheters
Child*
Drug Therapy
Female
Hematopoietic Stem Cell Transplantation
Humans
Infant
Pediatrics
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pulmonary Circulation
Pulmonary Embolism*
Subclavian Vein
Thrombosis

Figure

• 

  Fig. 1. Chest radiograph during cardiopulmonary resuscitation shows increased haziness in the left lower lung field and suspicious right upper lung field consolidation. Both the previously inserted left-side catheter and the newly inserted right-side catheter are shown. The depth of the endotracheal tube and catheter seem to be adequate, and other possibilities of cardiac arrest such as tension pneumothorax were excluded.

Reference

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