Ultrasonography - The Need of Present Time for Central Venous Catheter Insertion in ICU

Background: This case report describes a subclavian vein cannulation that inadvertently led to an arterial puncture which led to haemothorax. This case emphasizes the importance of post - procedural imaging and the disadvantages of not using ultrasound guidance in central venous catheterization. Case Presentation: A 48 - year - old Caucasian female with history of CKD stage V on maintenance hemodialysis and hypothyroidism presented herself in emergency department with complain of breathing difficulty, generalized weakness and giddiness. Recently fistula was made on left upper limb, hence dialysis catheter was planned to insert in right subclavian vein. Ultrasound was not used; catheter was inserted with help of anatomical landmark technique. Inadvertently subclavian artery was punctured during the procedure. Pressure was applied & catheter was inserted in Right Internal Jugular Vein. Post procedure chest X ray showed large hematoma. USG Chest & CT Angiography was done. Surgical evacuation of hematoma was done under general anesthesia andIntercostal drainage was inserted. Conclusion: Use of ultrasound guidance for central venous catheter insertion allows direct visualisation of needle approach, direction & guidewire location. Real time guidance leads to decrease complications & improve the chances of success. The probability of success is higher as compared with traditional landmark technique. Homogeneous opacity in thorax immediately post procedure should raise the suspicion of haemothorax. This is a preventable complication with the help of ultrasound guidance.