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Case Report
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| Difficult venous access in a child with a severe form of scleromyxedema | ||||||
| Biljana Drašković1, Dragan Marinković2, Fabri Izabella3 | ||||||
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1Professor of Anesthesiology, Anesthesiologist, Department of Surgery, Medical Faculty, University of Novi Sad, Serbia Anesthesiologist, Head of department, Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Clinic of Pediatric Surgery, Institute of Healthcare of Children and Youth of Vojvodina, Novi Sad, Serbia.
2Anesthesiologist, Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Clinic of Pediatric Surgery, Institute of Healthcare of Children and Youth of Vojvodina, Novi Sad, Serbia. 3Teaching Assistant of Anesthesia, Department of Surgery, Medical Faculty, University of Novi Sad, Serbia.Anesthesiologist, Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Clinic of Pediatric Surgery, Institute of Healthcare of Children and Youth of Vojvodina, Novi Sad, Serbia. | ||||||
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| How to cite this article |
| Drašković B, Marinkovic D, Izabella F. Difficult venous access in a child with a severe form of scleromyxedema. Edorium J Anesth 2015;1:6–9. |
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Abstract
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Introduction:
Scleromyxedema, is a very rear condition of mucinous deposition and diffuse papular eruptions of the skin, accompanied by systemic complications.
Case Report: A case of a 12 years old boy whose disease first presented with multiple painful aphtous ulcers in his mouth, papular skin eruptions on his palms and soles and hyperthermia up to 38.3°C. Over a period of four years the disease advanced progressively with rapid spreading of the skin lesions on the boys extremities, trunk and neck. On our first contact with the patient, he was in a very altered health condition, severely underfed, almost paralized with rigid flexion of all of his proximal and distal joints. His skin was thick and unpenetrable, intravenous cannulation and administration of therapy, laboratory testing was impossible. Neck extension and mouth opening were severely limited. The positioning for central vein puncturing was impossible and therefore it was decided to place a central venous catheter under the control of ultrasound. The procedure took place in the operating theatre, under analgosedation with Chloral hydrate administered rectally and N2O/air mixture through a facial mask. The right internal jugular vein was cannulated using the out-of-plain technique, with a 18G catheter under the guidance of a 6 cm linear ultrasound probe. Conclusion: The procedure was successful with no intra- or postoperative complications. Ultrasound guided central vein insertion appeared to be of a major significance in this case of a very difficult vascular access, presenting as a safe, easy and lifesaving technique. | |
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Keywords:
Central venous catheters, Scleromyxedema, Ultrasonography
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Author Contributions
Biljana Drašković – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Dragan Marinković – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Fabri Izabella – Substantial contributions to conception and design, Acquisition of data, Analysis an interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2015 Biljana Drašković et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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