A case of femoral arteriovenous fistula caused by central venous catheterization under inadequate ultrasound guidance
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To the Editor
Arteriovenous fistula is a rare but severe complication of central venous catheterization [1, 2]. The use of ultrasound guidance for central venous catheterization is recommended to improve the success rate and reduce complications . However, a safe procedure cannot be performed without adequate knowledge and skill.
In our case, catheterization into the right femoral vein after penetrating the right femoral artery caused femoral arteriovenous fistula. The issue with the manipulation in this case was considered to be the gap between the probe and the needle insertion point of the skin preventing visualization of the needle tip at all times. Therefore, the penetration of the femoral artery by the needle was not recognized. When a central venous catheter is inserted with real-time ultrasound guidance (short axis view/out-of-plane approach), the skin insertion point should be located right next to the probe, and the needle tip should be visualized at all times until the target vein is punctured. In 2014, several key attributes for teaching safe ultrasound-guided central venous catheter insertion were proposed as follows: (1) a curriculum clearly describing the technical approach and cognitive elements required, preferably with video-based procedural examples; (2) hands-on simulation training to develop hand-eye skills; (3) an emphasis on techniques that allow visualization of the needle tip at all times; and (4) insertions supervised by experienced clinicians giving feedback for improvement .
Central venous catheter insertion is an invasive procedure that can lead to severe complications. When a central venous catheter is inserted with or without real-time ultrasound guidance, we must ensure it is adequately inserted.
Availability of data and materials
Data sharing is not applicable as no datasets were generated or analyzed during the current case report.
SY, KT, WK and HI read and approved the final manuscript.
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The patient provided her informed consent for the publication of this case report.
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We obtained consent in writing for publication from the patient.
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- 1.Jin L, Wang J, Wu C, Shao C, Yu X, Lei W. Femoral arteriovenous fistula associated with leg swelling 6 months after removal of a hemodialysis catheter: a case report. Medicine. 2015; https://doi.org/10.1097/MD.0000000000001738.
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