Abstract
We report our experience with two cases of erroneous puncture of the vertebral artery (VA) that occurred during our attempt at central venous catheterization via the internal jugular vein (IJV). Case 1 was a 2-year-old girl with hemolytic-uremic syndrome caused by enterohemorrhagic Escherichia coli O-111. A dialysis catheter placed in the left ventricle via the VA was confirmed by radiography and computed tomography. Thereafter, a concomitant arteriovenous fistula was also found, which necessitated percutaneous embolization. Case 2 was a 14-year-old boy with supravalvular aortic stenosis who underwent patch enlargement of the aortic annulus. The central venous catheter was inserted during anesthesia induction, and aberrant intrusion of the catheter into the left ventricle was confirmed by radiography. Surgery was carried out under cardiopulmonary bypass, and the catheter was removed postoperatively, without any associated arteriovenous fistula formation. Erroneous puncture of the VA may cause serious complications. To prevent erroneous puncture of the VA, it is necessary to identify the VA located dorsal to the IJV under ultrasonic guidance, and to avoid piercing the posterior wall of the IJV. In addition, to ensure medical safety, improvement of the skills of the operators for the procedure through improvement of the teaching methods is desirable.
