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J Am Coll Emerg Physicians Open
J Am Coll Emerg Physicians Open
10.1002/(ISSN)2688-1152
EMP2
Journal of the American College of Emergency Physicians Open
2688-1152
John Wiley and Sons Inc. Hoboken

10.1002/emp2.13278
EMP213278
Images in Emergency Medicine
Images in Emergency Medicine
Images of venipuncture injuries
JIAZHAO et al.
Jiazhao Li PhD https://orcid.org/0009-0001-5843-3728
1 fuwachouchou@qq.com

Wenxin Jiang MD 1
Yelin Shen   1
1 Department of Intensive Care Unit, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University Guangzhou China
* Correspondence
Li Jiazhao, Department of Intensive Care Unit, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
Email: fuwachouchou@qq.com

13 9 2024
10 2024
5 5 10.1002/emp2.v5.5 e1327802 8 2024
06 8 2024
© 2024 The Author(s). Journal of the American College of Emergency Physicians Open published by Wiley Periodicals, Inc. on behalf of American College of Emergency Physicians.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

air leak shadow
computed tomography
deep venipuncture
Science and Technology Project of GuangzhouSL2022A04J00128 source-schema-version-number2.0
cover-dateOctober 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:13.09.2024
Jiazhao L , Wenxin J , Yelin S . Images of venipuncture injuries. JACEP Open. 2024;5 :e13278. 10.1002/emp2.13278
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pmc1 PATIENT PRESENTATION

A 57‐year‐old female was admitted to the intensive care unit (ICU) following brain surgery. The process of deep venipuncture was challenging, as indicated by her lung computed tomography (CT) scans (Figures 1, 2, 3). Previously, she had a catheter in her left internal jugular vein, which was not functioning properly and was subsequently removed, leaving a retrosternal air leak shadow, as indicated by the red arrow in Figure 1. An attempt to puncture the right subclavian vein failed, resulting in residual gas trapped between the muscle layers (Figure 2) with a radius of 2 mm and an area of 13.21 mm2. Eventually, catheterization of the right internal jugular vein was successful after two failed attempts (Figure 3); some gas was observed near the catheter, with a maximum area of approximately 32 mm × 10 mm.

FIGURE 1 Residual gas (red arrow ahead) after removal of left internal jugular vein catheterization.

FIGURE 2 The gas shadow between the muscle layers remained (red arrow ahead) after the puncture of the right subclavian vein failed. The clavicle is above, and the first ribs are below.

FIGURE 3 After failing twice to puncture the right internal jugular vein, the gas shadow in the internal jugular vein can be seen (red arrow ahead) and near the side of the catheter.

2 DIAGNOSIS: VENIPUNCTURE INJURIES

The patient's vital signs remained stable during and after the procedure. A follow‐up lung CT performed 4 days later showed that all gas had been absorbed. However, deep venipuncture failures are common in clinical settings and can lead to complications, 1 such as mediastinal emphysema, peripheral nerve injury, 2 and pneumothorax, which in turn can result in economic burdens, prolonged hospitalization, and even fatalities—fortunately, this patient did not experience significant complications. However, the CT scan revealed past injuries, serving as a reminder for clinicians to exercise caution and rigor during invasive procedures.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ACKNOWLEDGMENTS

We thank the nursing staff at the Medical Intensive Care Unit for their care of this patient. This work was supported by Dr. Jing Yuanwen provided by Science and Technology Project of Guangzhou (Project umber: SL2022A04J00128). We thank Dr. Jing Yuanwen and the nursing staff at the Medical Intensive Care Unit for their care of this patient

DATA AVAILABILITY STATEMENT

No additional information is available for this paper.
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REFERENCES

1 Fujii C . Clarification of the characteristics of needle‐tip movement during vacuum venipuncture to improve safety. Vasc Health Risk Manag. 2013;9:381‐390. doi:10.2147/VHRM.S47490
2 Yamada K , Yamada K , Katsuda I , et al. Cubital fossa venipuncture sites based on anatomical variations and relationships of cutaneous veins and nerves. Clin Anat. 2008;21:307‐313. doi:10.1002/ca.20622
