• Ranjan Pathak, Paras Karmacharya, Madan Raj Aryal, and Richard Alweis.
• Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania - USA.
• J Vasc Access. 2014 Nov 1;15(6):537-40.

PurposeCentral venous catheterization is a commonly used procedure to gain access to the central circulation. Although ultrasound guidance decreases the complication rates, arterial puncture may still occur. Failure to recognize this early may lead to devastating complications such as thrombosis and embolic stroke. We discuss the factors associated with increased risk of arterial puncture, techniques to detect them early and the management of established carotid artery cannulation.MethodsWe report a case of internal jugular catheterization complicated by carotid artery puncture leading to embolic stroke.ResultArterial catheterization in the patient went unrecognized for 2 days. During this period, the patient developed catheter-related thrombus in the carotid artery, ultimately resulting in embolic stroke. Emergent open surgical repair of the vessels with thrombectomy was performed.ConclusionEven with ultrasound-guided central venous catheterization, it is essential to remain vigilant for the early detection of vascular complications. Clinical suspicion combined with diagnostic modalities such as chest radiograph, transduction and manometry can increase the detection rates.

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