Malposition of the central venous catheter: A diagnostic dilemma

Abstract

A 50-year-old male was admitted to Intensive Care Unit with head and chest injury needed multiple central venous catheter (CVC) for the long-term intravenous access. Right internal jugular vein was cannulated uneventfully, and the tip of CVC was confirmed in the chest radiograph along the right border of the mediastinum. After few days, left subclavian vein was cannulated and the procedure was uneventful. However, the postprocedure Chest X-ray showed the CVC along the left border of mediastinum rather than the right border. Possibility of CVC in one of the tributaries of left brachiocephalic vein was thought. Due to uncertainty in position of left CVC, we inserted CVC in right-sided subclavian vein, which was in normal position along the right border of mediastinum. Left subclavian CVC was removed. Reviewing the patient's thoracic computed tomography scan revealed, patient had congenital anomaly and double superior vena cava that explained the abnormal course of left subclavian CVC along the left border of mediastinum.

Pericardial Tamponade Caused by Perforation of Marshall Vein During Left Jugular Central Venous Catheterization

“…Veins such as the coronary sinus can also be perforated and lead to cardiac effusion in the absence of any structural abnormality in the cardiovascular system. More rarely, cardiac effusions occur in the presence of venous anatomical variations, which is well known by intensivists, invasive cardiologists, and cardiac electrophysiologists, as they create a challenge for catheter placement or lead placement [ 6 ].…”

Radiología e imagen del tórax en la Unidad de Terapia Intensiva

“…La mala posición del CVC no es una complicación de la inserción de una vía central; sin embargo, la mala posición del CVC no diagnosticada puede estar asociada con una morbilidad y mortalidad significativas. 16 Los catéteres de la arteria pulmonar deben estar con la punta en la arteria pulmonar proximal. Las líneas invasivas conllevan un riesgo asociado de neumotórax o hemotórax, que generalmente ocurren durante la inserción, y las complicaciones deben buscarse en la radiografía simple posterior al procedimiento.…”