MASSIVE RETROPERITONEAL HEMORRHAGE ASSOCIATED WITH FEMORAL VEIN CANNULATION

The right external iliac artery was inadvertently punctured during att empted right femoral vein catheterization. Severe hypotension develope d several minutes after the arterial puncture. Concurrently, a large r ight lower abdominal quadrant swelling (approximate to 5 cm in diamete r) became apparent. Laparoscopic observation of the retroperitoneal re gion immediately revealed massive retroperitoneal hemorrhage. Abdomina l computerized tomographic scan indicated development of a huge (appro ximate to 10 cm in die maximum diameter) retroperitoneal hematoma alon g the right psoas muscle from the level of the right external iliac ve ssels up to the level of the upper pole of the right kidney. Considera tion of the anatomy of the ''right'' femoral and retroperitoneal vesse ls (ie, mediolateral relationship between the vein and artery) led us to conclude that the site for insertion of the needle was too proximal and the angle for advancement of the needle too low in our patient, a llowing the needle to reach and injure the ''incompressible'' external iliac artery, thereby causing massive retroperitoneal hemorrhage. Alt hough femoral vein catheterization has generally been considered a rel atively safe method of intravenous access, a life-threatening serious complication call occur with the inappropriate technique used in our c ase.