Title
Inadvertent intrathecal placement of a pulmonary artery catheter introducer Inadvertent intrathecal placement of a pulmonary artery catheter introducer
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Publication type
article
Publication
Cleveland, Ohio ,
Subject
Human medicine
Source (journal)
Anesthesia and analgesia / International Anesthesia Research Society. - Cleveland, Ohio, 1957, currens
Volume/pages
117(2013) :1 , p. 119-122
ISSN
0003-2999
1526-7598
ISI
000326512300019
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
We present a case of unintended intrathecal cannulation by a pulmonary artery catheter introducer in a patient scheduled for coronary surgery. This complication was likely due to multiple attempts of placing the guidewire. Switching to the straight tip of the guidewire may have created a false route, facilitating entrance in the subarachnoid space. A lumbar intrathecal catheter was placed to maintain a low pressure at the cervical dural puncture site by draining 10 mL cerebrospinal fluid per hour. After removal of the lumbar drain, the patient experienced symptoms consistent with postdural puncture headache. Magnetic resonance imaging of the spine could not reveal the location of the possible leak. A lumbar epidural blood patch alleviated all complaints. One month later the patient underwent surgery successfully. We hypothesize that ultrasound imaging may have prevented this complication
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