Rare central venous catheter malposition – an ultrasound-guided approach would be helpful: a case report

Abstract

BackgroundA central venous catheter enables the measurement of hemodynamic variations, such as accurate central venous pressure; catheter malposition may induce potentially fatal complications. This case report describes a rare central venous catheter tip malposition in the right internal mammary artery.Case presentationA 56-year-old Japanese woman who presented with severe pneumonia secondary to scleroderma was treated under ventilator support because of acute respiratory failure. A right central venous catheter was inserted using a landmark technique to monitor central venous pressure and administer medications. However, central venous waveforms detected by the catheter using a pressure lot transducer were later found to be absent. Further imaging studies, including plain radiography, computed tomography, and angiography, confirmed central venous catheter malposition in the internal mammary artery. Her right internal mammary artery was embolized using two interlocking detachable coils, and the central venous catheter was removed from her internal mammary artery without further complications.ConclusionsInternal mammary artery malposition is a rare but potentially lethal complication of central venous catheter catheterization; however, caution should be taken regarding the assessment of risk factors and management of a severe complication. An ultrasound-guided approach would be helpful.

Stylistic features of case reports as a genre of medical discourse

“…In particular, they are used for the purpose of giving recommendations and warning other physicians (that is, implementation of the instructive function). In this context, the modal verb “should” plays a significant role as well (15 cases in the analyzed MCRs): “The psychological aspect of this condition should not be underestimated because he was ashamed of his front teeth and was not able to smile” [ 12 ]; “IMA malposition is a rare but potentially lethal complication of CVC that should be considered in risk factor assessments and the management of severe complications resulting from CVC” [ 13 ]; “…however, the risk of infection should be weighed against the advantages of this procedure” [ 8 ]; “We hypothesize that a difficult intubation should be anticipated in these patients” [ 9 ].…”

“…The present perfect tense is generally used to render the author’s reflections on the problem in a broader context (for instance, the results of other research, which occur primarily in the “ Background ” section of MCRs). The research has identified 180 cases of present perfect constructions (103 active and 77 passive sentences): “There have been a number of previous reports of CVC malpositioning in the internal mammary vein”; “Numerous complications of central venous catheterization have been reported ” [ 13 ]; “Other studies have demonstrated the ability of ablation to prevent recurrence of VF in patients with a structurally normal heart, but these studies also have been of small patient cohorts followed only for a few years” [ 7 ]; “Few cases of bilateral nasoalveolar cysts have been described” [ 8 ].…”

“…At the same time, our research has demonstrated the relatively seldom use of the future tense in MCRs (a total of 16 cases: 13 active and 3 passive sentences). Occasionally, the authors use it in the “ Conclusions ” section to provide a perspective for further research or a prognosis: “An ultrasound-guided approach rather than the use of a landmark technique to insert CVC will help ” [ 13 ]; “Patients will tolerate the procedure with adequate airway preparation using topical anesthesia” [ 9 ]; “Until the effectiveness of ablation for the prevention of VF has been confirmed in a large cohort of such patients followed for a substantial duration, we will continue to recommend ICD therapy for most survivors of VF arrest even if ablation is also performed” [ 7 ]; “The tooth will preserve the remaining alveolar ridge and help the adolescent psychologically” [ 12 ].…”

“…The use of the present simple tense is also comparatively infrequent and it is generally used only in the opening section of MCRs (23 cases in the analyzed discourse): “We report a rare case of a CVC tip malpositioned in the right internal mammary artery (IMA)” [ 13 ]; “ We describe the case of a 30-year-old man from the north of Morocco with no medical or surgical history and no family history of rectal disease” [ 6 ]; “ We describe a case in which RVOT ectopy was complicated by ventricular fibrillation (VF) arrest despite the absence of any of the recognized risk factor for cardiac arrest and despite an apparently positive response to pharmacological therapy” [ 7 ]; “Here, we present two cases where difficult intubation was anticipated, and in which, despite trying various devices to visualize and secure the airway, only the use of a Macintosh blade proved successful” [ 9 ]; “ We report a case of an acute psychotic relapse in response to polydrug use most notable for multiple recent binges of crystal methamphetamine” [ 11 ].…”