University of Wisconsin–Madison Medical College of Wisconsin

Ultrasound-Enabled Noninvasive Management of Inadvertent Carotid Cannulation

Stacy Libricz, PA-C; Ayan Sen, MD; Victor Davila, MD; Jeff Mueller, MD; Alyssa Chapital, MD, PhD; Samuel Money, MD

WMJ. 2018;117(3):126-129.

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Introduction: Despite ultrasound use, accidental carotid cannulation is possible during placement of a central venous catheter (CVC), requiring operative repair of the carotid artery and removal of the catheter.

Case Presentation: We report 2 cases—a 59-year-old Hispanic man and an 86-year-old white man—of inadvertent placement of a CVC into the left common carotid artery, removed via a pulland-pressure technique under real-time ultrasound guidance. No complications occurred and follow-up imaging was negative for fistula creation, hematoma, or cerebral infarcts.

Discussion: Prior cases have reported accidental carotid cannulations that required operative repair. Our discussion focuses on the complications of removal of CVCs from the common carotid, and the utility, feasibility, and safety of using real-time ultrasound guidance in the removal.

Conclusion: While operative removal of CVCs accidentally placed in the carotid is recommended, an ultrasound-enabled pull-and-pressure technique may prevent complications and avoid need for surgical repair in critically ill patients.

Author Affiliations: Department of Critical Care (Libricz, Sen, Chapital); Department of Vascular Surgery (Davila, Money); Department of Anesthesiology (Mueller); Mayo Clinic Arizona, Phoenix, Ariz.
Corresponding Author: Ayan Sen, MD, MSc, FACEP, FCCP, Consultant, Critical Care Medicine, Assistant Professor, Emergency Medicine/Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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