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Pulmonary puzzles
A central venous catheter that revealed a vascular paradox
  1. Savvoula Savvidou,
  2. Entela Koco,
  3. Matthew Tsagourias,
  4. Dimitrios Matamis
  1. Department of ICU, ‘Papageorgiou’ General Hospital, Thessaloniki, Greece
  1. Correspondence to Dr Savvoula Savvidou, ‘Papageorgiou’ General Hospital, Ring Road N.Efkarpia-Thessaloniki, Thessaloniki 56402, Greece; ssavidou{at}med.auth.gr

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Clinical presentation

A 60-year-old man with insignificant past medical history, was admitted to the intensive care unit with acute respiratory failure following community-acquired pneumonia. On admission, he was haemodynamically stable in sinus rhythm, febrile and neurologically intact with no focal neurological findings. Under mechanical ventilation, the ratio of arterial oxygen (PaO2) to fractional inspired oxygen concentration (FiO2) was 100. An antibiotic regime of ceftriaxone plus moxifloxacin was administered.

On day 6, a 3-lumen central venous catheter (CVC) (Arrow, 7 Fr x 20 cm, polyurethane radiopaque) was easily inserted into his left internal jugular vein using anatomical landmarks. Aspiration of blood from the distal tip of the catheter confirmed its intravascular placement; however, the sample's bright red appearance strongly suggested it was ‘arterial’ in origin. Bedside B-mode ultrasonography excluded false cannulation of the carotid artery. Furthermore, connection of the CVC with a pressure transducer produced a venous waveform with low pressure. Blood gas analysis of the CVC sample returned a PaO …

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