Accidental Puncture of the Common Carotid Artery
- typically squirting bleeding after puncture
- after removal of the puncture cannula, light compression of the carotid artery, bleeding then usually stops, if not -> exposure of the common carotid artery and oversewing
Pneumothorax
- rare in puncture of the subclavian vein, even rarer in puncture of the internal jugular vein
- mostly mantle pneumothorax without clinical relevance
- but: in principle, postoperative X-ray examination of the thorax
Catheter Malposition
- leads to problems during dialysis
- Causes:
- incorrect positioning of the catheter tip (should be at the transition of the vena cava to the right atrium or directly in the right atrium)
- kinking of the catheter in the arched course before creation of the subcutaneous tunnel
- catheter sutured too tightly directly outside the catheter exit site with a thread
- accidental positioning in the azygos vein
- Prophylaxis:
- intraoperative fluoroscopy for position control
- multiple flushing of the catheter (both limbs!) with heparin-saline solution; should be possible effortlessly without "jerking" as should aspiration; in case of abnormalities, possibly also phlebography via catheter
- kinking of the catheter can be avoided by puncturing the internal jugular vein very low directly above the clavicle -> catheter can then be guided in a wide arc over the clavicle and led out over the thoracic wall