Seizures and hemiparesis after subclavian vascular access

We present a patient with seizures and hemiparesis with long-lasting sequellae following injection of medication and total parenteral nutrition through a centrally placed catheter. The central catheter was inadvertently placed arterially even though no suspicion for incorrect placement had been raised on control chest X-ray. When there is difficult central venous access or doubt about the correct positioning of a catheter, position should be confirmed with chest X-ray in combination with pressure measurement and/or blood gas analysis. At present there is no evidence for specific treatment of neurological symptoms after arterially administered total parenteral nutrition.