Bowel Puncture During Insertion of a Femoral Central Line in the Emergency Department

Patient: Female, 46-year-old Final Diagnosis: Bowel perforation Symptoms: Decreased level of consciousness Medication: — Clinical Procedure: Central venous catheterization Specialty: Critical Care Medicine OBJECTIVE: Unusual clinical course BACKGROUND: Central venous catheter (CVC) insertion is commonly performed in the emergency department. The femoral vein is often chosen for insertion of CVCs due to its lower risk for complication. We present a rare complication of bowel puncture during insertion of a femoral CVC in the emergency department in a 46-year-old female. CASE REPORT: A 46-year-old female with a history of partial gastrectomy and colostomy was transported to the emergency department after being found unconscious. Despite multiple attempts, intravenous access could not be obtained. The emergency physician proceeded to insert a left femoral CVC to obtain venous access. Ultrasound was not used due to perceived urgency, as well as a bedside assessment that the patient’s anatomy was straight forward. Stool-like material was aspirated upon inserting the introducer needle, which was quickly removed. An upright x-ray showed no free air, but due to the patient history, an exploratory laparotomy was performed. A single-side perforation in the mid-sigmoid with a small hematoma along the antimesenteric wall was found. The puncture was over sewn, and the patient recovered well; the patient’s initial presentation was ultimately considered to be due to medication misuse. CONCLUSIONS: This case highlights the importance of using caution in blind attempts at femoral CVC in patients with prior abdominal surgery. It is also important to note the need to avoid insertion of CVCs without the use of ultra-sound or when in a rush. If venous access is needed quickly, peripheral or intraosseous venous access can be obtained much more quickly and safely.