Practice guidelines provide checklists to decrease complications during central venous introducer placement. Fixation of introducers should rely on institutional practice, which may include suturing, stapling, or an adhesive method.1,2  Our institutional practice uses a two-point suture securement technique: one at the suture wing and a second wrapped around the introducer’s hub (Panel A).

Panel B illustrates a 9Fr ARROW Percutaneous Sheath Introducer (Teleflex, USA) with an inadvertent retention suture through the sheath. The practice guideline checklist recommends securement after aspiration and flushing. Before fixation, the sheath was immediately aspirated, revealing venous blood. After fixation, repeat aspiration revealed an air-filled venous blood mixture within the side port tubing and fluid leakage at the insertion site.

Introducer damage during fixation may be secondary to various factors: limited visibility, restricted neck rotation, emergent access,...

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