Arterial Cannulation Near-Miss During Jugular Venous Catheterization With Carotid Artery Aneurysm: A Case Report.

IF 0.5

A&A Practice Pub Date : 2023-02-01 DOI:10.1213/XAA.0000000000001661

William C Culp, Michael Beitzel, Shawn Malan, Kelsea C Wright

引用次数: 0

Abstract

Central venous catheterization is a common procedure that may lead to inadvertent arterial cannulation, potentially causing bleeding, hematoma, stroke or rarely, death. In this near-miss case presentation, an aneurysmal carotid artery was misidentified with ultrasound by a junior resident, nearly leading to placement of a sheath into the artery. This case highlights arterial punctures that still occur even with ultrasound guidance. Further, training inadequacies as well as anatomic, cultural, and production pressure factors led to this potentially highly morbid near-miss. Physician teachers should critically evaluate teaching methods to confirm that trainees are learning skills as intended. (A&A Practice. 2023;17:e01661.).

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颈动脉动脉瘤颈静脉置管术中动脉插管险些漏诊1例。

中心静脉置管是一种常见的手术，可能导致无意的动脉插管，可能导致出血、血肿、中风或罕见的死亡。在这个侥幸的病例中，一位初级住院医生用超声错误地识别了动脉瘤性颈动脉，几乎导致在动脉中放置了一个鞘。本病例强调即使在超声引导下仍会发生动脉穿刺。此外，训练不足以及解剖学、文化和生产压力因素导致了这种潜在的高度病态的未遂事件。医师教师应批判性地评估教学方法，以确认受训者正在学习所需的技能。[j] .会计实务。2023;17:e01661.]

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

A&A Practice ANESTHESIOLOGY-

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期刊介绍： A & A Case Reports, our new online journal publishing Case Reports, related Editorial Commentary, and Correspondence. Anesthesia & Analgesia 1 and Anesthesiology 2 recently announced that they were suspending publication of Case Reports. One reason is that Case Reports typically reduce the Impact Factor of a journal because they are rarely cited. Regardless of the merits of Impact Factor as a metric of journal worth, journals and their editors necessarily consider Impact Factor in strategic planning. At the same time, Case Reports are appreciated by readers for describing “real life” management of difficult or unusual cases not often encountered by practitioners. In a recent issue of Anesthesia & Analgesia, Steven Shafer1 identified many Case Reports whose publication launched productive careers dedicated to solving the puzzle posed by an unusual observation in a single patient.