Central Venous Catheter Malposition into the Left Internal Mammary Vein in Patient with Coagulation Disorder and Safe Removal: A Case Report

Abstract

A 61-year-old male patient with underlying diseases of hypertension and alcoholic liver cirrhosis was hospitalized for liver transplantation due to advanced liver cirrhosis. In preparation for liver transplant surgery, a multi-lumen access catheter and Swan-ganz catheter are inserted into the right internal jugular vein. And another central venous catheter is inserted into the subclavian vein for central venous pressure measurement and drug administration. There was no abnormal resistance of the guide wire or catheter that the operator could feel during the insertion process, and there was no abnormality in the function of the catheter. But the postoperative chest image showed that the left subclavian central vein catheter was malpositioned. Through venography at the angiography room, it was confirmed that the central venous catheter was inserted into the left internal mammary vein. Since the patient with coagulation disorder, special attention was required to remove the catheter. In addition, due to the location of the internal mammary vein, it was expected that it would be difficult to compress for hemostasis after removal of the catheter. Therefore, it was necessary to check the patient's coagulation test to determine the appropriate time of the catheter removal and cooperation of the radiologist.