Z. Jankovic, A. Boon, R. Prasad British Journal of Anaesthesia

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Fatal haemothorax following large-bore percutaneous cannulation before liver transplantation Z. Jankovic, A. Boon, R. Prasad British Journal of Anaesthesia Volume 95, Issue 4, Pages 472-476 (October 2005) DOI: 10.1093/bja/aei216 Copyright © 2005 British Journal of Anaesthesia Terms and Conditions

Fig 1 (I) The Medtronic 21 Fr femoral arterial catheter and introducing trocar. The catheter (17 cm effective length) and dilator (60 cm) are both made of soft polyurethane. The catheter has a large distal end hole and four smaller side holes on four sides up to 6 cm back from the tip. The device can be clamped at the site shown by the arrow. There is a luer lock aspiration port proximally (fine arrow). (II) Stiff additional dilator; (III) plastic dilator. British Journal of Anaesthesia 2005 95, 472-476DOI: (10.1093/bja/aei216) Copyright © 2005 British Journal of Anaesthesia Terms and Conditions

Fig 2 Anteroposterior (AP) chest X-ray. The bypass catheter is descending into the right hemithorax close to the mediastinal margin. British Journal of Anaesthesia 2005 95, 472-476DOI: (10.1093/bja/aei216) Copyright © 2005 British Journal of Anaesthesia Terms and Conditions

Fig 3 Autopsy view of the tip of the bypass cannula misplaced in the right pleural cavity. British Journal of Anaesthesia 2005 95, 472-476DOI: (10.1093/bja/aei216) Copyright © 2005 British Journal of Anaesthesia Terms and Conditions

Fig 4 Artistic impression of one potential mechanism of injury. (a) Misplaced guide-wire in the subclavian vein. (b) The stiff dilator cannot curve enough to follow the guide-wire. The wire is kinked and the vessel torn. (c) The tip of the bypass catheter is inserted to lie outside the vessel. RSV, right subclavian vein; SVC, superior vena cava; BC, brachiocephalic vein; RIJV, right internal jugular vein; GW, guide-wire. British Journal of Anaesthesia 2005 95, 472-476DOI: (10.1093/bja/aei216) Copyright © 2005 British Journal of Anaesthesia Terms and Conditions