Perioperative Echocardiography to Confirm Correct Central Venous Catheter Placement: A Case Report

Abstract

Central venous catheterization is widely regarded as a safe procedure by anesthesiologists and intensivists, but insertion complications and catheter malposition remain challenges for the clinicians performing central venous catheter (CVC) insertion. We report a case in which a right internal jugular CVC was inserted under ultrasound guidance and was found to be malpositioned after sternotomy into an anomalous posterior thymic vein. Therefore, we recommend confirming the correct position of CVC with transesophageal echocardiography if such is indicated for the perioperative period and emphasize the importance of a correct J-tip of the guidewire when placing a CVC.

Catheter Misplacement Following Subclavian Vein Catheterization Under Ultrasound Guidance: An Infrequent and Unusual Malposition

“…We believe that the use of echocardiography (transthoracic or transesophageal) in this setting would have confirmed the absence of the guidewire tip in the RA or SVC-RA junction and would have prompted reinsertion of the introducer needle and guidewire. 4…”

“…3 Proper orientation of the introducer needle and guidewire and use of echocardiography to visualize the guidewire tip will aid in correct placement of the guidewire into the superior vena cava (SVC)-right atrium (RA) junction and reduce the incidence of malposition during central venous catheterization. 4 Written informed consent was obtained from the patient’s relatives for publication of this report and image. This article adheres to the guidelines laid by Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network.…”