When one port does not return blood: two case reports of rare causes for misplaced central venous catheters

Abstract

We present two cases of misplaced central venous catheters having in common the absence of free blood return from one lumen immediately after placement. The former is a case of right hydrothorax associated with central venous catheterization with the catheter tip in intra-pleural location. In this case the distal port was never patent. In the latter case there was an increased aspiration pressure through the middle port due to a catheter looping. The absence of free flow on aspiration from one lumen of a central catheter should not be undervalued. In these circumstances the catheter should not be used and needs to be removed.

Right Management and Flushing

“…For example, absent blood return on aspiration is frequently documented in published case studies as a warning sign (Rolden and Paniagua 2015) and an important clue into the identification of catheter tip malposition, or a misplaced/dislodged Huber needle. These situations can result in serious safety implications for patients (Goossens 2013;Hackert et al 2005;Pereira et al 2013;Breitling 2010). Pereira et al (2013) presents two cases of malpositioned CVADs whereby the only clinical feature that indicated a problem was the absence of free flowing blood return.…”

“…These situations can result in serious safety implications for patients (Goossens 2013;Hackert et al 2005;Pereira et al 2013;Breitling 2010). Pereira et al (2013) presents two cases of malpositioned CVADs whereby the only clinical feature that indicated a problem was the absence of free flowing blood return. The case studies conclude that this safety check should not be undervalued (Pereira et al 2013).…”

“…Pereira et al (2013) presents two cases of malpositioned CVADs whereby the only clinical feature that indicated a problem was the absence of free flowing blood return. The case studies conclude that this safety check should not be undervalued (Pereira et al 2013). Blood return check is not 100% infallible, as demonstrated by two case studies that report CVAD malposition despite successful aspiration of blood return (Losert et al 2000;Klockgether-Radke and Gaus 2004).…”

Coiling of central venous catheter: A rare and preventable complication

“…The formation of a loop in CVC is a rare complication occurring mostly during right-sided catheterization. [ 2 ] We report a rare complication of coiling of left subclavian CVC.…”

Coiling of shaft of the central venous catheter inside left subclavian vein- a case report

“…The coiling or knotting of the catheter inside the vein can lead to increased risk of catheter breakage and embolization, no free aspiration of the blood and erroneous or falsely high central venous pressure measurement. 3,4 Besides, this can cause trauma to the vessel wall and can increase the risk perforation and thrombosis. 4 The coiling of the shaft of the central venous catheter inside the subclavian vein is not a common finding.…”