A 56-year-old male was admitted on January 17, 2024, due to experiencing bleeding for one day following tooth scaling. A complete blood count with a white blood cell count of 35.09 × 10^9/L, hemoglobin level of 67 g/L, red blood cell count of 1.97 × 10^12/L, and platelet count of 18 × 10^9/L. Coagulation profile testing showed a prothrombin time of 16.90 s, an international normalized ratio (INR) of 1.41, and a fibrinogen level of 1.61 g/L. After admission, the patient underwent intensive treatment, including transfusions of human fibrinogen, packed red blood cells, fresh frozen plasma, and single-donor platelets. Standard therapy was initiated, consisting of all-trans retinoic acid (ATRA) for differentiation induction, tigecycline for anti-infection therapy, and carbazochrome sodium sulfonate injections for hemostasis. On the third day of admission, he was subsequently diagnosed with AML M2 based on bone marrow cytology findings.

Considering the patient’s need for long-term chemotherapy, blood product transfusions, and other supportive treatments, central venous catheterization was planned on the 6th day of admission. The pre-puncture laboratory results were as follows: Coagulation profile (January 22, 10:50): Prothrombin Time (PT): 17.50s, International Normalized Ratio (INR): 1.45, Activated Partial Thromboplastin Time (APTT): 51.2s, Thrombin Time (TT): 18.6s, Fibrinogen (FIB): 2.13 g/L, D-dimer: >20 µg/mL. Complete Blood Count: White Blood Cell (WBC): 101.96 × 10^9/L, Hemoglobin (Hb): 59 g/L, Platelet (PLT): 73 × 10^9/L, Table 1. Ultrasound-guided cannulation of the right internal jugular vein was successfully performed, utilizing a 5 French (1.7 mm outer diameter, 20 cm length, 16 Ga) central venous catheter. The catheter, model Bioptimal CV-501-20YT, was gently advanced to a depth of 12 cm within the vein. The procedure was successfully completed on the first attempt by an experienced anesthesiologist, and the patient experienced no significant discomfort.

A local hematoma appeared, four hours after jugular vein puncture and catheterization, and the hematoma gradually enlarged, extending to the right shoulder and back. Local compression was applied to control bleeding, and oxygen was administered via nasal cannula at 3 L/min. Seven hours later, the hematoma continued to progress, and the patient complained increasing respiratory difficulty. The ultrasonography revealed a diffuse hematoma in the soft tissues of the right neck, approximately 40 mm in thickness, with the right internal jugular vein catheter in situ. Due to the severity of the patient’s condition, he was subsequently transferred to the intensive care unit (ICU) for continued management.

After admission to the ICU, carotid artery computed tomography angiography (CTA) confirmed the catheter’s position and ruled out significant arterial injury, Fig. 1. Subsequently, a series of nursing and supportive treatments were administered in the ICU.

CT and CTA findings of the patient’s neck. A:Right-sided cervical hematoma. B:Hematoma compressing the trachea. C:CTA indicates no arterial injury. D:Central venous catheter in place

Regrettably, 14 h following admission to the ICU, the patient suffered an acute intracerebral hemorrhage accompanied by brain herniation, presenting with altered consciousness and dilated pupils. Due to the patient’s inability to maintain adequate oxygen saturation and ensuing respiratory failure, endotracheal intubation was initiated following consultation with the family. Considering the uncontrollable bleeding, surgical intervention was not pursued. After thorough communication, the patient’s family ultimately decided to withdraw further treatment. Subsequently, the patient succumbed to their condition.