Suffocation after failed insertion of a central venous catheter

The complication rate for catheterization of the cervical veins depends highly on the skills and the experience of the doctor and is approximately 2%. In addition to a pneumothorax, puncture of the A. carotis interna is the most frequent complication (80-90%). In the case described here, a 68-year-old female patient with acute myeloblastic leukaemia died of suffocation after a failed catheterization of the internal jugular vein. After two attempts at placing the catheter dyspnoea developed rapidly and intubation of the barely sedated patient failed. After a tracheotomy and failed ventilation attempts the hypoxic women A died - in the presence of nine doctors. The forensic autopsy revealed, among other things, two injuries to the A. carotis with an extensive haematoma and an extratracheal position of the tracheal tube. Knowledge of anatomy, skilled performance and experienced handling of possible complications can minimize serious consequences of this routine intervention.