Azygos catheter placement as a cause of failure of dialysis

Stewart, G; Jackson, Alan C.; Beards, S. C.

doi:10.1016/s0009-9260(05)81242-5

Cited by 14 publications

(10 citation statements)

References 5 publications

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“…There were 13 cases reported in 9 articles [11,14,[17][18][19][20][21][22][23][24] that clearly documented the misplacement of HDCs into the azygos arch. These 13 cases included 12 tHDCs and 1 temporary (non-tunneled) HDC miscannulation [19] (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…In one case, the catheter tip pointed right-upward indicating that it entered the AV arch from a right-posterior direction (report no. 1; Table 1) [18]. In case report number 11 (Table 1) [17], the radiological image showed the catheter tip had followed the azygos arch reaching the level of thoracic vertebra; the anterior-posterior chest radiography showed a very short catheter tip pointing to the carina horizontally.…”

Section: Discussionmentioning

confidence: 97%

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Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility

Zhang

et al. 2019

Blood Purif

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Background: Central venous catheter (CVC) is commonly used to provide access for hemodialysis (HD) when arteriovenous access is not available. The misplacement of CVC into azygos vein (AV) is a rare but a potential serious complication. Previous reports communicated the opinion that left-sided catheterization predisposed to AV misplacement, but these reports concentrated on peripherally inserted CVCs, placed for indications rather than HD. Unintended AV misplacement of HD catheters (HDCs) has not been well studied. We seek to investigate factors associated with inadvertent AV miscannulation during HDC placement. Methods: We are to present a case of unintentional misplacement of a tunneled HD catheter (tHDC) into the azygos arch from right internal jugular vein (RIJV) despite real-time fluoroscopy guidance. Additionally, we have undertaken a systematic literature search in Pubmed to study the anatomical and other factors related to unintended AV misposition in HD setting. Results: From 2005 to August 31, 2018, a total of 11 articles containing 16 cases of misplacement of HDCs into AV were identified. Of the 17 cases of unintentional AV misposition including ours, the majority of the misguided HDCs (94.1%, 16/17) were tHDCs and only 1 case was related to a temporary (non-tunneled) catheter. Most catheter misplacements (88.2%, 15/17) were performed without real-time radiological guidance. The reported incidence of inadvertent AV cannulation from different institutions varied between 0.6% and 3.8%. Among the 16 misplaced tHDCs, the rates of AV misposition that arose from RIJV and left internal jugular vein (LIJV) insertion are even at 50%. Conclusions: Based upon anatomical and case studies, we have found that AV may join posterior aspect of superior vena cava at different directions and levels. Hence, this might explain why AV misplacement might occur whether an HDC is inserted from the LIJV or RIJV approach. By raising the awareness of this potential complication and how we may minimize it, we hope to reduce the future complication of AV misposition.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility

Zhang

et al. 2019

Blood Purif

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“…5 Intentional transjugular azygos tip placement for hemodialysis catheters has been reported in two patients with SVC occlusion 6 as well as inadvertent placement of central venous catheters into the azygos system. 7,8 Unfortunately, these were not viable options in this patient as the prior femoral vein/IVC to azygos vein catheter was nonfunctional. In addition, the patient would likely not tolerate a complex endovascular or hybrid procedure in the setting of severe hyperkalemia.…”

Section: Trans-popliteal Access For Treatment Of Life-threatening Hypmentioning

confidence: 99%

Trans-popliteal access for treatment of life-threatening hyperkalemia when all other conventional access fails

et al. 2018

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“…6, 2005 / pp. 583-590 Deviations of placement / function of permanent central vein catheters for hemodialysis I. SKANDALOS 1 , A. HATZIBALOGLOU 2 , I. EVAGELOU 1 , T. NTITSIAS 1 , A. SAMARAS 1 , G. VISVARDIS 3 , K. MAVROMATIDIS 4 , K. KARAMOSHOS 1 In 5 cases (1.5%) the catheter was inserted into the contralateral innominate vein (Fig. 1).…”

Section: Artificial Kidney and Dialysismentioning

confidence: 99%

“…Aberrant placement of permanent central vein catheters for hemodialysis are rare conditions usually connected to the way they are inserted (contralateral innominate vein) or with the obstruction of a major vein trunk as the superior and inferior vena cava (azygos, hemiazygos, internal thoracic, ascending lumbar veins) (1)(2)(3)(4). Poor function is connected with the obstruction of a major vein trunk such as the superior and inferior vena cava (5), when the blood flow is via the extensive collateral veins.…”

Section: Introductionmentioning

confidence: 99%

Deviations of Placement / Function of Permanent Central Vein Catheters for Hemodialysis

et al. 2005

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Fourteen cases of malposition of a permanent central vein catheter for hemodialysis or poor blood flow associated with thrombosed central veins but correct catheter positioning, in 13 patients suffering from end stage renal disease, presented from September 1991 to December 2003 among 385 permanent central vein catheters for hemodialysis (3.6%). There were 8 episodes of catheter tip malplacement in the azygos vein (1 case), hemiazygos vein (1), left internal thoracic (mammalian) vein (1), contralateral innominate vein (5) and 6 cases with correct anatomical catheter tip placement but with blood inflow from the catheter through the collateral vein system because of thrombosis of a major vein trunk (hemiazygos vein system (2), azygos vein (2), ascending lumbar veins (1), or portal vein system (1)). The malposition was diagnosed using roentgenography, with or without contrast, and computer tomography. In 3 cases the catheter was removed, in 5 cases the position was corrected. In the remaining 6 cases its function was maintained using anticoagulation or/and thrombolytic therapy. In conclusion, the placement of a permanent central vein catheter for hemodialysis must be followed by simple or contrast medium x-ray evaluation of its correct position or function. The malposition must be corrected whereas in the case where there is no alternative solution the function of the catheter may be maintained in the incorrect position using a combination of anticoagulation or/and thrombolytic therapy.

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Azygos catheter placement as a cause of failure of dialysis

Cited by 14 publications

References 5 publications

Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility

Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility

Trans-popliteal access for treatment of life-threatening hyperkalemia when all other conventional access fails

Deviations of Placement / Function of Permanent Central Vein Catheters for Hemodialysis

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