Femoral vein catheterization is often carried out during
resuscitation and in
critical care units. It is usually achieved via a blind, external landmark-guided technique, through manual localization of the femoral artery. However, this approach can be challenging in patients with severe
shock because of absence or ambiguity of the arterial pulse. We report a case of inadvertent cannulation, with a large-bore
catheter, of the right femoral artery, which was mistaken as a venous route for medication and massive transfusion. The large
cannula caused direct mechanical obstruction, while intra-arterial medications induced
vascular injury and vasospasm. Both factors led to
thrombosis and occlusion of the right external iliac artery, thus jeopardizing the distal blood supply, and ultimately resulting in muscle
necrosis of the involved limb, and the need for
thrombectomy and extensive
fasciotomy to salvage the extremity. This case highlights that correct placement of a
central venous catheter should be clearly ascertained before the
catheter is used for medical treatment, especially when catheterization is performed in
shock status.