IMAGES IN EMERGENCY MEDICINE
Inadvertent cannulation of the C6 transverse foramen during central venous catheterisation
1 Department of Neurosurgery, Derriford Hospital, Plymouth, UK
2 Department of Neuroradiology, Derriford Hospital, Plymouth, UK
3 Department of Intensive Care Medicine, Derriford Hospital, Plymouth, UK
Correspondence to:
Correspondence to Mr Neil Barua , Department of Neurosurgery, Derriford Hospital, Derriford Road, Plymouth PL6 8DH; neilbarua@doctors.org.uk
Accepted 2 September 2008
| The first 150 words of the full text of this article appear below. |
A 37-year-old man on warfarin presented to the emergency department with reduced conscious level following a fall. A computed tomography scan of the brain revealed an acute subdural haematoma. Before transfer to a neurosurgical unit, a right internal jugular central venous catheter was uneventfully inserted under ultrasound guidance. Postoperatively he remained sedated and ventilated. Before lightening of sedation, a cervical spine computed tomography scan was performed, which demonstrated the catheter to have traversed the right C6 transverse foramen (fig 1). Aspiration of blood and blood gas analysis confirmed the venous placement of the catheter. The catheter was removed without complication. Cannulation of the vertebral vein in the right C6 transverse foramen has been reported previously in a 13-year-old boy, in whom the position of the catheter remained undetected for 5 months.1 Excess lateral rotation of the head at the time of insertion may have contributed to the unusual
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Emerg. Med. J. 2009 26: 687.[Extract] [Full Text] [PDF]
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