1. Quality and outcomes in anaesthesia: lessons from litigation
J.P. Adams, M.D.D. Bell, A.R. Bodenham 
British Journal of Anaesthesia 
Volume 109, Issue 1, Pages (July 2012)
DOI: /bja/aes188
Copyright © 2012 The Author(s) Terms and Conditions

2. Fig 1
Transverse ultrasound image through the right infraclavicular axillary (subclavian) vessels. The vein can be cannulated with ultrasound guidance just proximal to this site to avoid most procedural problems associated with traditional landmark subclavian access. Note indistinct pleural edge (P) on this image, axillary artery (AA), axillary vein (AV), cephalic vein (CV), an arterial branch of axillary artery (the thoracoacromial trunk TAT), and brachial plexus (BP).
British Journal of Anaesthesia  , DOI: ( /bja/aes188)
Copyright © 2012 The Author(s) Terms and Conditions

3. Fig 2
A right verterbral artery (VA) and carotid artery (CA) angiogram, vessel diameters in mm shown. Contrast is seen exiting the vertebral artery (arrow). The complete image series showed contrast flowing from the anterior aspect of the artery into a paravertebral venous plexus and then into the IJV, a so-called vertebro-jugular AV fistula. This occurred after a first pass needle approach to the right IJV, without ultrasound guidance and presented late with tinnitus and a bruit. The vertebral artery required stent repair. A fuller description of the legal background to this case, including the place of ultrasound guidance, has been presented in a recent BJA editorial.55
British Journal of Anaesthesia  , DOI: ( /bja/aes188)
Copyright © 2012 The Author(s) Terms and Conditions

4. Fig 3
An axial CT of the chest at the level of the aortic arch. A catheter (arrow) has been inadvertently inserted via the right carotid artery into the ascending aorta (AA), during attempted right internal jugular cannulation with the use of ultrasound. Note the close proximity of the SVC to the ascending aorta which meant misplacement of this catheter was not obvious on plain chest X-ray. In this case, the catheter misplacement was recognized when the patient developed neurological signs (TIA) on the catheter use. The catheter was left in situ in the short term with systemic heparin therapy, followed by urgent open surgical catheter removal, thrombus removal, and arterial repair.
British Journal of Anaesthesia  , DOI: ( /bja/aes188)
Copyright © 2012 The Author(s) Terms and Conditions

5. Fig 4
On table angiography imaging. One lumen of a twin-lumen (Tesio type 10 Fr) large-bore central venous dialysis catheter (a) has been passed through the right subclavian artery into the right pleural space after attempted right IJV cannulation with the use of ultrasound. An additional guidewire and introducing sheath (b) from the same original vessel puncture site is also within the arterial tree crossing the midline into the descending aorta. There are signs of a developing haemothorax in the right mid-zone (vertical arrows). There are clips and wires from previous thoracic surgery. The subclavian artery tear was successfully repaired by radiological stenting.
British Journal of Anaesthesia  , DOI: ( /bja/aes188)
Copyright © 2012 The Author(s) Terms and Conditions