Misplacement of hemodialysis catheter to brachiocephalic artery required urgent sternotomy

Abstract

The cuffed, tunnelled hemodialysis catheterization through the right internal jugular vein is widely used for mid- to long-term hemodialysis for patients with renal failure. The purpose of this report is to address the potentially lethal complication among the variety of surgical problems in conjunction with this procedure. The case also illustrates the potential pitfalls in the management of renal failure. A 65-year-old woman had a misplaced 14F-sized hemodialysis catheter insertion to the ascending aorta via the neck of brachiocephalic artery. The patient underwent urgent removal of the catheter through median sternotomy. It was found that the catheter went into the brachiocephalic artery just 1-2 cm distally from the aortic arch. She recovered slowly despite the fact that she developed a cerebellar infarct, which was thought to be caused by a thromboembolism from the catheter, she also developed heart failure, pneumonia and septic shock postoperatively. Arterial catheter misplacement inside of the chest is a potentially lethal complication. Open surgical treatment should be considered for the major chest arterial injury.