Oliguric patients with acute kidney injury (AKI) often requires an internal jugular vein or femoral venous catheter to establish vascular access for emergency hemodialysis. Puncture with catheterization (PC) of the right internal jugular vein (RIJV) is relatively simple and is often the first choice for hemodialysis catheters insertion. However, complications such as bleeding and hematoma at the puncture site can occur, and in rare cases, the hemodialysis catheter (HDC) can be misplaced into the internal carotid artery, subclavian artery, subclavian vein, or even the thoracic cavity and mediastinum, leading to intractability for processing next. In this study, we report a case of an elderly female patient with AKI who underwent RIJV puncture for long-term HDC because her renal function had not recovered in the short term, and the lower end of the catheter penetrated the superior vena cava (SVC) into the mediastinum due to operator’s carelessness. We did not perform open surgery or endovascular interventions, and instead, the HDC was retained in that place for four weeks and then directly removed without surgery. The patient did not experience any problems, such as bleeding or hematoma, and has been receiving hemodialysis from femoral catheter subsequently since then. doi: https://doi.org/10.12669/pjms.39.2.6674 How to cite this: Li X, Ran F, Guo Y. Perforation of the superior vena cava by a tunnel-cuffed hemodialysis catheter via the right internal jugular vein in an elderly woman. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6674 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The present study reports the case of an elderly male inpatient with uraemia who had a sudden onset of numbness and weakness in the right limbs during sleep at night, accompanied by blurred and double vision, during the induction of haemodialysis (HD). Cranial computed tomography and magnetic resonance imaging revealed signs of brainstem haemorrhage. Consequently, a proactive treatment approach was adopted for decreasing the blood and intracranial pressures of the patient, and regular HD was continued. The condition of the patient improved, and the limbs showed no impairment of sensation, with normal movement. To the best of our knowledge, this is the first reported case of an inpatient with uraemia undergoing HD who developed a sudden brainstem haemorrhage during the induction phase of HD and completely recovered after conservative treatment. This unusual case deserves the attention of all clinicians, who should pay more attention to the patients with spontaneous brainstem hemorrhage.

For haemodialysis in patients with uraemia, catheterization of the internal jugular or femoral vein is often required to establish access. Puncture with catheterization in the right internal jugular vein (RIJV) is relatively simple, and thus, is the appropriate choice for haemodialysis. However, catheterization at this site can lead to complications, including bleeding at the puncture site. Moreover, in several cases, the haemodialysis catheter (HDC) can be misplaced in the internal carotid artery and subclavian artery, thus making the management troublesome later on. In this article, we report the case of a middle-aged female patient with uraemia wherein a temporal HDC was misplaced into the right subclavian artery during right internal jugular vein catheterization. Instead of conventional surgery and endovascular intervention, the catheter was left in that place for four weeks and subsequently removed directly, followed by local compression for 24 hours. ---Continue