Detection of Severe Neurological Complications Caused by the Removal of Central Venous Catheter Accidentally Inserted in the Epidural Space via Motor-Evoked Potential: A Case Report

The central venous catheter (CVC) has been in clinical use for more than half a century. It was initially used for total parenteral nutrition. However, its indication gradually expanded to chemotherapy, intensive care, anesthesia, and other areas. As the application of CVCs increased, complications also increased. Nevertheless, some guidelines for CVC insertion have been implemented, and clinicians worldwide are working hard to prevent complications during CVC insertion. However, the safety of CVC removal has not been given adequate attention. Because of a few reports on complications, such as air embolism and airway obstruction, clinicians are recognizing the potential risks associated with CVC. However, a few medical staff recognize the possibility of associated neurological complications. We herein report a case of a patient who underwent anesthesia for the removal of a CVC, which was inadvertently inserted in the epidural space. The catheter was used to monitor central venous pressure and as a route for medicine administration before the recognition of its abnormal position. Although the distal luminal wave pattern was similar to that of a normal central venous line, heparin did not exert its expected effect after administration from the distal lumen. Conversely, appropriate blood pressure responses were observed following the administration of inotropic agents from the proximal lumen. Objective neurological monitoring was required for removal because of the involvement of general anesthesia. After general anesthesia induction, the surrounding tissue of the CVC was dissected toward the deep layer of the neck. Arterial bleeding occurred immediately after removal. After 33 minutes, the motor-evoked potential (MEP) waves deteriorated. Angiography showed bleeding from the left vertebral artery into the spinal canal. Consequently, emergency coil embolization of the left vertebral artery was performed, followed by emergency laminectomy to decompress the spinal canal. All procedures were completed, and the MEP waves completely recovered. The postoperative course was uneventful, and the patient was discharged after 17 days. In this case report, we discuss the appropriate removal steps for a CVC inadvertently placed in the epidural space.