Anesth Pain Med.  2023 Oct;18(4):382-388. 10.17085/apm.23052.

Guidewire insertion into the vertebral vein during right internal jugular vein central venous catheterization -A rare case report-

• Lee J
• Suh J
• Oh J
• Ki S

• KMID: 2550918
• DOI: http://doi.org/10.17085/apm.23052

Abstract

Background
Internal jugular veins are the most frequently accessed site for central venous catheterization in patient management, whereas complications involving vertebral veins are a rare occurrence. Case: A 73-year-old male suspected to have a urothelial carcinoma was scheduled for elective left nephroureterectomy. During central venous catheterization using the anatomic landmark technique to target the internal jugular vein, a guidewire is inadvertently inserted into the suspected vertebral vein. Following the correction of the catheterization, a radiologist reviewed the preoperative enhanced computed tomography and confirmed that the initially punctured vessel was the vertebral vein. On the third day after surgery, the central venous catheter was removed, and the patient did not exhibit any complications, such as bleeding, swelling, and neurological symptoms. Conclusions: The use of ultrasonography during central venous catheterization is recommended to evaluate the anatomy of the puncture site and prevent misinsertion of the catheter, which can lead to several complications.

Keyword

Anatomic landmark; Catheterization; Central venous catheter; Computed tomography; Jugular vein; Ultrasonography

Figure

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  Fig. 1. Ultrasonography. (A) A larger vessel where the second guidewire was inserted is located superiorly and more laterally than the vessel that was first punctured. (B) The course of both veins, where the guidewires were inserted, descends toward the right brachiocephalic vein. Red arrow: vertebral vein; white arrow: internal jugular vein.

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  Fig. 2. The central venous catheter, which was cannulated using the second inserted guidewire, is located near the right atrium and follows the superior vena cava.

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  Fig. 3. Contrast-enhanced computed tomogram. (A) The axial view at the seventh cervical vertebral level reveals a suspected vein running from the vertebral foramen of the sixth cervical vertebra. (B) Coronary view of the same computed tomogram also reveals an escape of the suspected vein from the sixth vertebral foramen. Red arrow: suspected vein.

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