Inadvertent arterial catheterization complicating femoral venous access for haemodialysis

Abstract

Objective. Large-bore catheters for temporary haemodialysis are often placed via the internal jugular or femoral vein, guided by external landmarks or ultrasound techniques. Inadvertent femoral artery catheterization may occur during attempted placement of the dialysis catheter in the femoral vein. Material and methods. This investigation was carried out in Skåne University Hospital, Malmö, Sweden. Between 2008 and 2011, patients referred for consultation by a vascular specialist owing to inadvertent arterial catheterization after attempted placement of a dialysis catheter in the femoral vein were noted in a logbook and patients with iatrogenic arterial injuries undergoing vascular repair at Malmö–Lund Hospitals were identified through the Swedish vascular registry (Swedvasc). Results. The five included patients had a dialysis catheter (11–13.5 Fr) inserted, without ultrasound guidance, into the femoral artery. One patient suffered from circulatory shock. Two cases were managed with external compression, while three cases required surgical repair. Two patients had postoperative wound infection in the groin. Conclusions. Femoral dialysis catheters should be inserted using ultrasound guidance. Large-bore catheters suspected of being in an inadvertent arterial position should be fixed securely before further diagnostic or interventional considerations. A management algorithm for inadvertently placed catheters in the femoral artery is proposed.

Key Words::

• catheterization
• central venous catheter
• femoral artery
• femoral vein
• renal dialysis
• vascular system injuries

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.