Jd. Knottenbelt et P. Bautz, HEMOTHORAX - A SOURCE OF ERROR IN EMERGENCY CENTRAL VEIN CANNULATION, South African Journal of Surgery, 31(3), 1993, pp. 120-121
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.