Time to abandon chest X-rays in favor of intracavitary ECG or echocardiography for central venous access tip location: A case of a malpositioned CICC into the internal mammary vein

Abstract

Central vascular access devices (CVADs) correct tip location is of paramount importance to avoid malposition related complications. Despite recent guidelines recommend avoiding postprocedure radiograph in favor of alternative tip location technology, chest X-rays are still widely used in clinical practice as a CVADs tip location method. We present a clinical case of a central inserted central catheter (CICC) malposition in the right internal mammary vein, erroneously interpreted by chest X-rays as correctly placed, in a critically ill patient.

Catheter misplacement from an implantable central venous access port into the internal thoracic vein: a case description

“…The right internal jugular vein is the most commonly used approach for CVport placement ( 2 ). Catheter misplacement is an early complication of CVport implantation and often occurs in the internal jugular vein, brachiocephalic vein, subclavian vein, azygos vein, or right atrium ( 3 ). Catheter misplacement into the internal thoracic vein (ITV) is rare ( 4 ).…”