A Rare Complication of Subclavian Central Venous Catheterization: Puncture of the Pulmonary Artery

鎖骨下中心靜脈導管置放術的罕見併發症：肺動脈穿刺

許哲偉(Che-Wei Hsu) ； 蕭合莆(Ho-Fu Hsiao) ； 毛宏鑫(Hung-Hsin Mo)

《輔仁醫學期刊》 10卷4期 (2012/12) Pp. 211-216

摘要

一位過去病史患有腦部中風與糖尿病的67歲女性病人因為泌尿道感染合併敗血症住進區域醫院。住院當中因病情惡化併發突發性心跳停止，經過搶救後恢復生命跡象並轉送醫學中心。在急診處病患仍然呈現嚴重休克情況，所以我們立即施行鎖骨下中心靜脈導管置入術。我們在術後的胸部X光上發現中心靜脈導管的走向異於平常的位置，於是安排胸部電腦斷層檢查。立體重組影像中顯示該中心靜脈導管從第一第二肋間穿過胸腔直接穿入主肺動脈。除了少量的心包膜積血外，並沒有發生氣胸的情況。經過仔細的評估後，由胸腔科醫師進行胸腔內視鏡手術順利將此中心靜脈導管移除。

關鍵字

鎖骨下靜脈 ； 中心靜脈導管置入術 ； 肺動脈穿刺

並列摘要

A 67-year-old obese woman with diabetes mellitus and a previous stroke was admitted to a local hospital under a diagnosis of urosepsis. In-hospital cardiac arrest occurred, and cardiac pulmonary resuscitation was successfully performed. She was later transferred to our emergency department where she presented with profound shock. Emergent central venous catheterization via the left subclavian vein was performed. A follow-up chest radiograph showed an unusual route of the catheter. We obtained a chest computed tomographic scan of the patient, and the reconstructed tomogram showed that the tip of the catheter had penetrated the main trunk of the pulmonary artery with mild hemopericardium. The patient did not present with significant pneumothorax. The catheter had punctured the thoracic cavity between the first and second ribs. After complete evaluation, the catheter was smoothly removed under the assistance of video-assisted thoracoscopic surgery by a chest surgeon.

並列關鍵字

subclavian vein ； central venous catheterization ； pulmonary artery penetration