How to manage the malposition of deep vein catheterization into the artery?

Central venous catheterization establishes temporary, efficient, and rapid use of deep venous access in patients, which provides high flow rate fluid perfusion, enables measurement of central venous pressure, and acts as an important reference for clinical decision-making.However, various complications such as pneumothorax, hemothorax, hematoma, and puncture failure can easily occur during the puncture and catheterization process, which can impede its efficacy.Among these complications, accidental insertion of the puncture needle into the artery occasionally occurs, especially when inserting a thick sheath.Improper handling can lead to local hematoma, hemorrhagic shock, and immediate life-threatening risks.Relevant imaging examinations should be performed as soon as possible to determine the location of arterial injury and decide the correct therapeutic pathway.In this article, the author summarizes three recent cases wherein central venous catheterization inadvertently entered an artery.Finally, we proposed an algorithm to delineate the optimal treatment strategy to guarantee optimal management of these patients.Here are three cases of supra-aortic arterial lesions treated with different techniques described.Case 1 An 84-year-old male patient was diagnosed as acute heart failure.In order to provide essential support, a 7F left subclavian vein central venous catheter was inserted with the guidance of ultrasound imaging.The measurement of blood gases assessing a high degree of oxygenation confirmed the diagnosis of an arterial lesion.The patient was immediately transferred to the catheterization room, and the catheter was confirmed through the central venous catheter multi-position angiography (Figure 1A).Considering the relatively external puncture point, the relatively straight subclavian artery, and the large rib space