Saturday January 9, 2010
Central Venous Access on Same Side of Hemothorax

A 25-yr-old man is admitted to the emergency room after motor vehicle accident on new year night. CXR showed a right-sided hemothorax. You inserted right chest tube draining 2 litres of blood. Thinking as chest tube is already placed you inserted subclavian vein central line on same side (right) with good return on all 3 ports. You started volume resuscitation. Repeat CXR shows full resolution of the hemothorax and central line in lower SVC. Despite continuous volume replacement with multiple pRBCs and 4 liters of LR and colloid blood pressure continues to deteriorate and increased drainage of blood from the chest tube noted. For faster resuscitation you placed large bore (cordis) line in left femoral vein. More volume is given through the new femoral line and patient seems to stabilize. Repeat CXR showed reaccumulation of hemothorax. Patient taken to OR but found to have a diagnosis of laceration of major vessel due to central line placement instead of original trauma. New left IJ line placed and patient stabalized.