Central Venous Cannulation is a routine procedure done in the Operation Theatre and the Intensive Care Unit. Malpositioning is a very common occurance with the regular anatomical landmark technique. As the central venous catheters are essential in various critical care scenarios, hence any misplacement can hamper its purpose. Here we have three cases where in we saw the migration of the Right Subclavian Vein Catheter into the Ipsilateral Internal Jugular Vein, Contralateral Subclavian Vein and into the Ipsilateral External Jugular Vein radiologically. Hence a thorough knowledge of normal and variant anatomy is required for the proper positioning of Central Venous Catheters. Also radiological techniques like ultrasound guided cannulation may avoid inadverdent arterial puncture but may not be able to avoid malpositioning.

No abstract

Mediastinal impalement is uncommon and often fatal injury. Patients with this injury has to undergo operative intervention regardless of the hemodynamic status or associated injury. Few cases have been reported in which the patient recovered without any sequelae. We present a case of mediastinal impalement injury in which a metallic foreign body entered through the right 5 th intercostal space just lateral to sternal border. The patient became unconscious and then stabilised hemodynamically and neurologically .The foreign body penetrated pleura, lung of right side and right atrium. Right anterolateral thoracotomy was done for its retrieval. Follow-up of the patient was uneventful.