Anatomy Revisited: Hemodialysis Catheter Malposition into the Chest

Abstract

In most situations, central catheters are implanted in the right jugular vein as initial access for hemodialysis. However, after repeated punctures, the proximal vessels become stenosed and thrombosed and misplacement is likely to occur. Correct catheter position in the vein can be easily ascertained with X-ray or cross-sectional CT imaging. In this report, we describe the case of a 77-year-old patient on chronic hemodialysis via catheter due to arteriovenous fistula dysfunction. We placed a cuffed-tunneled hemodialysis catheter in the left internal jugular vein. Malpositioning of the catheter led to perforation of the great veins and migration of the catheter tip into the chest. It is important to be aware of the risk of potential incorrect positioning of dialysis catheters. Due to the stenosis and fragility of the vessel wall, perforation may occur. In cases of doubt, correct placement of large-bore catheters via the internal jugular vein should be verified by means of appropriate imaging before hemodialysis is performed.

The Value of CT Angiography Based on Intelligent Segmentation Algorithm for Survival of Hemodialysis Patients

“…In this study, the proportion of stent implantation is relatively high, accounting for 7/10 of the total number of cases. The main reason is that these patients have a high degree of occlusion, and venous lumen retraction still occurs after PTA expansion [ 22 ].…”

Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem

“…The present study showed that, compared to other well-established causes of catheter dysfunctions, such as central venous stenosis, fibrin sheath formation, and thrombus formation, the occurrence of mechanical problems, such as catheter malposition, was relatively low, which is consistent with previous studies ( 21 ). Dysfunction immediately noted after TCC placement is usually caused by mechanical problems, such as catheter malposition or venous perforation, which, albeit rare, can lead to an emergency resulting in high mortality rates ( 11 , 22 ). However, gentle equipment handling and careful fluoroscopic monitoring of the guidewire, dilator, and peel-away sheath placement through Digital Subtraction Angiography (DSA) can avoid this catastrophic event ( 23 ).…”

“…Then, PTA and an appropriate covered stent was deployed. Venous injuries occur less frequently than 1% ( 41 ), however, appropriate and prompt actions are crucial in the initial management of this potentially fatal complication ( 11 , 42 ). This complication is partly due to the large caliber of TCCs, which can lead to severe hemorrhage.…”

“…The prevalence of TCCs usage varies from 2% to 49%, depending on geographical region (4). However, the use of catheters carries the highest risk of adverse events, such as infection, mechanical kinking, malpositioning of the catheter tip, thrombus accumulation, growth of a fibrin sheath, and inadequate blood flow, leading to poor dialysis adequacy (4)(5)(6)(7)(8)(9)(10)(11). Various medical management protocols have been developed to address these problems, such as flushing the TCC lines with fibrinolysis protocols, reversing the TCC lines, and even TCC exchange (2,12,13).…”

Pericardium catheterization using a tunneled-cuffed catheter for hemodialysis: A lesson

“…After consulting with cardiologists and surgeons, the catheter was removed with atrial septal defect occluder (BalMedic ® : 6) 2 to avoid cardiac tamponade. Various misplacements and malpositioning have been previously reported, including catheter malpositioning leading to the perforation of large veins and catheter tip migration into the chest, 3 as well as misplacement of a right internal jugular vein HD catheter into the mediastinum. 4 Our case of inadvertent placement of a TCC into the pericardium is rare and, to our knowledge, previously unreported.…”