Right subclavian vein catheterisation: inadvertent catheter insertion intothe subclavian artery and the ascending aorta.

The accidental subclavian artery puncture is usually obvious, We report a c ase of unrecognized arterial catheterisation. The catheter had been inserte d during anaesthesia after return of dark and non pulsatile blood, and not controlled by a chest radiograph. During surgery, the injection of 30 mL is otonic saline containing 4 g of piperacillin for antibiotic prophylaxis res ulted in a transient circulatory collapse associated with ECG tracing of my ocardial ischaemia, Postoperative chest radiograph showed that the catheter was in a midsternal position, at the level of the ascending aorta. The int racoronary penetration of piperacillin was considered as the cause for the transient cardiocirculatory changes. The various diagnostic tools of the in traarterial location of the catheter are discussed. All inadvertent subclav ian artery catheterisations published in the literature have been carried o ut with multi-lumen catheters. The latter can contribute to the failure to recognize the arterial puncture and catheter insertion because of the use o f a small bore needle (Seldinger's technique) and infusion with electrical pumps. (C) 1999 Elsevier, Paris.