Anterior Mediastinal Central Line Malposition

Abstract

Central venous catheter (CVC) placement is a routine procedure in the management of critically ill patients. It is important to ensure correct positioning of the catheter tip just above the junction of the superior vena cava and the right atrium, to reduce associated complications and to optimize catheter function. The incidence of catheter misplacement is approximately 3%-4% for both subclavian and internal jugular vein access procedures. CVC placement in the right subclavian vein is associated with a higher risk of malposition.(1) We report an unexpected secondary malposition of a right subclavian CVC in the anterior mediastinum, with resultant vena caval perforation in a patient admitted to the neuro-critical care unit after undergoing a craniotomy procedure.

A Rare Central Venous Catheter Malposition: A Case Report

“…Turi reported a case of catheter placement at the anterior mediastinum, following superior vena cava perforation (5). Trunjillo described two cases of accidental placement of a central venous catheter in the left pericardiophrenic vein (6).…”

Misplacement of central venous catheter into the left internal mammary vein

“…There have, however, been case reports of central venous catheter misplacement in the anterior mediastinum with vena cava perforation and even accidental placement into the intrapleural cavity [7][8]. The blood gas result confirmed that it was situated in a vein.…”

“…The blood gas result confirmed that it was situated in a vein. There have, however, been case reports of central venous catheter misplacement in the anterior mediastinum with vena cava perforation and even accidental placement into the intrapleural cavity [7][8].…”

Mediastinal malposition of catheter after venous cut down

“…Turi et al found accidental placement of catheter in anterior mediastinum on during routine postoperative head computed tomography scan. 7 Kosmadakis et al reported a case of bilateral pleural effusion with mediastinal hematoma following misplaced tip of hemodialysis catheter in anterior mediastinum. 8 Leang et al and Kumar et al reported misplaced catheter in the pleural space.…”