We assume that, in our case, this unusual misplacement is also explained by anatomical variations among individuals. From previous literatures, it seems that CVC tip can go anywhere depending on anatomical variations among individuals. Malpositioning to other sites such as azygous vein, hemiazygous vein, pericardium, pleura, and peritoneum are also reported, but misplacement into the contralateral IJV is a very rare event. Malpositioning is a very common complication related to subclavian vein catheterization, with the rate going as high as 9.1%, and the most common site of malposition is to ipsilateral IJV.
Repeat ultrasound and chest radiography by C-arm confirmed correct position of CVC tip in the superior vena cava.
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This time assistant was asked to provide transient bilateral manual compression of IJV. In order to correct this malposition, the catheter was pulled up to 6–7 cm and reinserted over the guidewire maintaining proper asepsis. įigure 1: Chest radiograph showing the migration of catheter from subclavian vein to ipsilateral internal jugular vein Central venous catheter malposition is still not uncommon This was further confirmed by ultrasonography (USG) saline flush test and C-arm radiography inside operating room. On ultrasound screening further, the catheter tip was found in the contralateral IJV, an extremely rare site of malposition. We tried visualizing common sites of catheter tip malposition like such as ipsilateral IJV and contralateral subclavian vein using high frequency linear probe of ultrasound with no luck. Guidewire went in smoothly without any resistance, and backflow of blood was confirmed in all three ports of CVC, but as during the guidewire insertion, there was no electrocardiogram change, we suspected possible malpositioning of the catheter. One assistant was asked to place pressure on the ipsilateral IJV when the guidewire was being threaded in the subclavian vein in order to prevent migration to ipsilateral IJV. Under general anesthesia, a 7 Fr triple lumen CVC placement was attempted on the right subclavian vein using Seldinger technique. We report an unusual case of CVC malposition, wherein catheter inserted through the right subclavian vein migrated toward the contralateral internal jugular vein (IJV).Ī 28-year-old female with torcular meningioma was posted for craniotomy and excision of the tumor. Even in the most experienced hands, CVC insertion still remains a procedure with many complications, one of them being catheter malpositioning. Available from: Ĭentral venous catheters (CVC) are routinely placed in both perioperative and intensive care environment. From subclavian vein to contralateral internal jugular vein: Central venous catheter malposition is still not uncommon.
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How to cite this URL: Pathak S, Kaushal A, Gupta P, Singh S. How to cite this article: Pathak S, Kaushal A, Gupta P, Singh S.
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