Inadequacy of near-infrared spectroscopy cerebral oximetry monitoring for detecting neurological complication

Near-infrared spectroscopy (NIRS) cerebral oximetry is an established and standard monitoring modality for surgery under extracorporeal circulation with circulatory arrest. It helps to reduce the neurological complication, but in many instances, it becomes not only technically challenging but also is difficult to interpret and take corrective action based on the NIRS values. In this case study, we aimed to present the inadequacy of cerebral oximetry for detecting neurological complication.

Fluid infusion into the pericardium resulting from accidental displacement of a subclavian venous cannula.

A patient for double valve replacement developed an unusual complication consequent to extra-vascular displacement of a port of a central venous catheter, placed through the right subclavian vein. The patient had an uneventful surgical course and the trachea extubated after routine mechanical ventilation. Patient developed excessive mediastinal drainage later, which was noticed to be watery in nature. The source of the drainage was found to be a port of the central venous catheter, draining extra-vascular into the subclavian vascular sheath and thereafter through the pericardium into the mediastinal drains.