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BJA Advance Access published online on January 14, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei055
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005
Accepted November 11, 2004

Case Report

ECG recording of central venous catheter misplaced in inferior thyroid artery

W. Schummer 1*, C. Schummer 1, M. Paxian 1, R. Fröber 2, and U. Settmacher 3

1 Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-University, Erlanger Allee 103, 07747 Jena, Germany
2 Institute of Anatomy I, Friedrich-Schiller-University, Teichgraben 7, 07740 Jena, Germany
3 Department of General and Visceral Surgery, Friedrich-Schiller-University, Erlanger Allee 103, 07747 Jena, Germany

* To whom correspondence should be addressed.
W. Schummer, E-mail: cwsm.schummer{at}gmx.de


  Abstract

A 71-year-old male patient with liver metastases secondary to rectal carcinoma was scheduled for hemi-hepatectomy. Two months earlier he had undergone subtotal resection of the thyroid gland. Prior to surgery, a triple-lumen catheter and an introducer sheath were introduced into the right internal jugular vein using a landmark technique. No problems occurred during insertion of the triple-lumen catheter, but resistance was noticed during insertion of the 8.5 FG introducer sheath. After placement of the introducer sheath, intra-arterial misplacement was confirmed using a pressure transducer. The opportunity was taken to record and compare intravascular ECG by the arterial and venous catheters before removal. No difference was noticed in the P-wave patterns; both showed a marked increase. Surgical exploration of the neck, recommended by the vascular surgeon consulted, showed that the carotid artery was not injured. The introducer sheath had completely punctured the right internal jugular vein and entered the inferior thyroid artery. A thrill was felt. The management of this case is discussed, with suggestions for best practice. Intravascular ECG was unhelpful in differentiating between venous and arterial placement of the catheter.

Keywords: monitoring, electrocardiography, diagnostic use; veins, central venous catheterization, adverse events; veins, internal jugular.
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