Central venous catheter insertion site infection leading to subcutaneous emphysema

Abstract

Citation: Parul M, Gaurav V, Ajay K, Smita P.Central venous catheter insertion site infection leading to subcutaneous emphysema.Anaesth Pain & Intensive Care 2014;18(3):315-16

A 20-year-old lady presented to our hospital with pain and distension of abdomen, feculent vomiting and inability to pass faeces and flatus since 15 days. She looked sick, was febrile, and had a pulse rate of 140/min, blood pressure 76/40 mmHg, respiratory rate 34/min and SpO2 87% (room air). On auscultation, chest had bilateral crepitations. Abdominal examination revealed guarding and rigidity with absent bowel sounds. A diagnosis of intestinal obstruction with septic shock was made. Oxygen therapy, fluids and noradrenaline infusion was started. A central venous catheter (CVC) was inserted in right subclavian vein. Standard general anesthesia was administered for laparotomy. The small bowel had adhesions, stricture and a perforation for which loop ileostomy with urobag laparostomy was done. After completion of surgery, in view of her poor general condition and unstable vitals, anesthesia was not reversed and she was shifted to the ICU for further management. In the ICU, she received ventilatory support (SIMV+PS), broad spectrum antibiotics, vasopressors, parenteral nutrition and other supportive care.