Misinsertion of central venous catheter into the suspected vertebral vein: a case report

Abstract

We experienced a case in which a central venous catheter (CVC) was misplaced into the wrong vein, which was mistaken for the internal jugular vein (IJV), identified by chest x-ray and ultrasound. The vertebral vein passes through the transverse foramina from the atlas to the 6th cervical vertebra. After exiting the transverse foramen of the 6th vertebra, the vein subsequently runs anterolateral to the vertebral artery and posterior to the IJV and drains the innominate vein. In this case, chest x-ray and ultrasound revealed that the inserted CVC had a course very similar to the vertebral vein. The misplacement of a CVC into the vertebral vein might occur from excessive rotation of the patient's head, which leads to alterations in the cervical vascular anatomy, and from deep insertion of the puncture needle. Therefore, it is advised, for safe CVC insertion, to minimize a patient's head rotation and to make use of ultrasound when the anatomical structures cannot be clearly identified.

Bleeding of the Superior Vena Cava Due to an Iatrogenic Injury to It during the Ultrasound-Guided Central Venous Cannulation

“…Moreover, the RIJV follows a short and straight path to the SVC, which makes it easier to perform the CVC for the SVC. Therefore, the possibility of misplacement of a cannula in wrong vessels can be minimized [10,11]. This explains why we performed the first and second session of the CVC for the RIJV in our case.…”

“…The CVC can be performed via diverse veins according to a clinician's preference, indications for it and a patient's medical conditions [10]. The RIJV has been the preferred site for the CVC because it is easy to place a cannula in the RIJV by using the anatomical landmarks of the internal carotid artery (ICA) and the sternocleidomastoid muscle (SCM) [10]. Moreover, the RIJV follows a short and straight path to the SVC, which makes it easier to perform the CVC for the SVC.…”

Malpositioning of Central Venous Catheter from Right Internal Jugular Vein into Ipsilateral Vertebral Vein: A Rare Phenomenon

“…Although the displacement of central line from right internal jugular vein into vertebral vein is relatively rare, it can be identified on ultrasonography as the coiling of CVC from 6 th or 7 th cervical transverse process and going upwards or on chest radiograph as was seen in our case. 12 Main possible contributing factors are excessively rotating the patient's head and deep insertion of puncture needle. The later was thought to be the cause of displacement in our patient.…”

Ultrasound-guided internal jugular vein cannulation: a novel technique for confirming that the guidewire is directed towards the right atrium

“…Indeed, there have been numerous reports of misplacement of CVCs. 3,4 We suggest a simple maneuver to supplement correct IJV cannulation and subsequent CVC advancement towards the RA.…”