A Needle's Misdirection: Unravelling Vascular Injuries in Malpositioned Central Venous Catheters and Safe Removal Approaches
Sue Anne Han, Ahmad Khalis, Kan Chan Siang, Ahmadi Salleh, Mohamad Arif MN
Central venous catheters (CVC) are commonly inserted to obtain vascular access. Complications such
as vascular injuries arising from malpositioned CVC may occur, and safe surgical removal is required
to prevent further complications. We retrospectively reviewed all patients treated in the cardiothoracic
surgery department at our institution in the past 10 years for intrathoracic vascular injuries in
malpositioned CVC without the need for concurrent cardiac or thoracic surgical procedures. Among the
21 patients in our series, 2 patients (10%) had a single arterial injury, 16 patients (76%) had venous
injuries only, and 3 patients (14%) had both arterial and venous injuries. 16 patients (76%) underwent
surgery to remove the malpositioned CVC; majority of them underwent sternotomy (n=12, 57%) and 7 of
them had repair of blood vessels, and 4 patients (19%) underwent video assisted thoracoscopic surgery
(VATS). 2 out of the 5 patients who had their CVC directly removed followed by external compression
required emergency sternotomy due to pericardial effusion. In patients with artery or mediastinal vessel
injuries, a sternotomy approach was preferred, whereas VATS was chosen when subclavian vessels or
brachiocephalic vein injuries were noted. Endovascular procedures are alternatives for high surgical
risk patients, but these advanced procedures are currency limited due to high expertise and facilities
requirements.
