Case 1—1996 inadvertent carotid artery cannulation during pulmonary artery catheter insertion

Abstract

Case 1 A 61-year-old woman was scheduled for urgent orthotopic liver transplantanon. Four months before admission, she developed a flulike illness with acute jaundice. Liver function studies were consistent with acute hepatitis A. Three months later, she was admitted to a regional medical center with fatigue, ascites, and an exacerbation of her liver function abnormalities (SGOT[ALT] 2543 U/L and SGPT[AST] 1868 U/L). Her deterioration continued and she developed a coagulopathy (prothrombin time (PT) 19 sec/control 10.5 sec) and encephalopathy. A percutaneous liver biopsy showed submassive hepatic necrosis, and she was evaluated for potential orthotopic liver transplantation. Physical examination on admission showed a jaundiced woman who was minimally responsive. In the intensive care unit (ICU), her trachea was intubated for airway protection, and an arterial catheter was inserted. Medications included omeprazole, lactulose, solumedrol, synthroid, and spironolactone. Twelve hours after admission, she was brought to the operating room for liver transplantation. The protocol for vascular access involved placement of an 18-gauge right radial arterial catheter, an 8.5F rapid infusion cannula (Arrow International, Reading, PA) in the right antecubital vein, a vasoactive infusion port pulmonary artery catheter (Baxter Healthcare Corp, Irvine, CA) (PAC) in the right internal jugular vein (IJV), and an 8.5F cannula in the left IJV. This latter catheter was connected to a rapid infusion system for transfusion of blood products. The patient was sedated with midazolam, 6 rag, and scopolamine, 0.3 mg IV, and catheter placement was accomplished uneventfully. Unfortunately, the donor liver was found to be unsuitable and the patient was transferred to