HEMOTHORAX - A SOURCE OF ERROR IN EMERGENCY CENTRAL VEIN CANNULATION

Central venous cannulation is often performed in patients with penetra ting wounds of the chest as an aid to diagnosis, and is sometimes also used as a volume infusion resuscitation line in an emergency. The tra ditional signs of successful central venous cannulation - free aspirat ion of blood from the exploring needle and inserted cannula, free infu sion flow and backflow of blood when the set is lowered below the pati ent - may all give a false impression of correct placement if there is a significant haemothorax on the same side. Two cases are described w here the cannula was sited in a pleural cavity which contained blood, leading to inadequate resuscitation of the patient. The authors recomm end that, where possible, peripheral lines or saphenous cutdown be use d for volume resuscitation and that central venous cannulation in the emergency situation be performed on the side of the uninjured hemithor ax, especially if the operator is inexperienced.