Measurement of central venous pressure is widely practiced in many hospitals at the present time. Monitoring the central venous pressure is essential in managing critical patients wigh septic, cardiogenic, or hypovolemic shock, and medical patients with renal or cardiopulmonary failure.
Since Wilson introduced the method of subclavian venipuncture for fluid maintenance in 1962, the techniques of infraclavicular, supraclavicular subclavian venipuncture and internal jugular vein catheterization has become popular, with the following serious complications beening noted: Hydrothorax, hemothorax, perforation of heart, and air embolism.
In an example case, a 31 year old male with a brain aneurysm ruptured was anesthetized for surgery and then a left subclavian vein catheterization was attempted with a supraclavicular approach. While attempting this procedure, a 20㎝ catheter slipped accidentally into vascular space during insertion. A chest X-ray was taken which showed the catheter tip located in the superior vena cava and the head of catheter lodged in the right ventricle. The operation was cancelled until two days later when he was anesthetized again, and at this time, the right supraclavicular subclavian vein catheterization was performed properly. The aneurysm operation had been completed successfully. On the twelve post operative day, patient was anesthetized for the third time and the removal of the catheter embolus was performed by median sternotomy. The superior vena cava was explored and the catheter was found immovable, adhering to the tissue of the blood vessel, but the embolized catheter was removed with a hemostat. Vital signs were stable through his whole hospital stay. He recovered satisfactorily from the median sternotomy and went home happily two weeks post sternotomy.
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