Correction of malposition of central venous catheter with 9-Fr introducer sheath assisted by mobile type diagnostic X-ray apparatus: a case report

Abstract

Central venous catheters provide long-term available vascular access. They are useful for central venous pressure monitoring, rapid fluid management, massive transfusion and direct cardiovascular medication, especially in operation. Central venous catheterization is usually performed by the landmark bedside technique without imaging guidance. The complications of central venous catheterization are frequent, which include malposition, pneumothorax, hemothorax, chylothorax, arterial puncture, hematoma, air embolism and infection. Malposition of a central venous catheter is not rare and may cause several complications such as malfunction of the catheter, default measurement of central venous pressure, catheter erosion, thrombophlebitis and cardiac tamponade. In this case, we report a malposition of central venous catheter with 9-Fr introducer sheath which is located in the right subclavian vein via ipsilateral internal jugular vein and the correction of this misplacement assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope).

A case of accidental displacement of a central venous catheter in lung parenchyma leading to hydrothorax: A case report

“…Ultrasound guiding minimizes the number of mechanical difficulties, catheter-placement failures, and the time required for insertion during internal jugular venous catheterization [ 14 ]. Insertion of guidewire during the procedure may also reduce the prevalence of CVC malposition [ 15 ]. In addition, studies suggest that type of catheter may also contribute in central venous catheter malposition.…”

“…In addition, studies suggest that type of catheter may also contribute in central venous catheter malposition. A soft silicon catheter is claimed to be more likely than a semi-rigid catheter to go in an unanticipated direction and cause more malpositioning [ 15 ]. Moreover, resistance during central venous catheter insertion, poor blood aspiration after insertion, aberrant waveform, and abnormally high CVP are all evident symptoms of catheter malpositioning [ 15 ].…”

Failure to place a tunneled hemodialysis catheter due to malformation of right internal jugular vein draining to subclavian vein

“…Almost all misplaced catheters that had been inserted into the SV had advanced smoothly and were subsequently found on routine radiographs. [6][7][8][9] Some authors suspected that this phenomenon was related to the fact that the patients were lying in bed with the head too far rotated to the left side, inducing a small angle between the IJV and SV that made misplacement of the guidewire into the SV possible. 8 Resistance during catheterization was felt in our patient; after adjusting the patient's position, repuncturing at another puncture point, and reinserting a J-shaped guidewire, the guidewire tip was still in the right SV although we called an anesthesia specialist for help.…”

“… 5 , 6 Misplacement of a right IJV catheter into the ipsilateral subclavian vein (SV) or axillary vein is rare. 6 – 8 We herein present a case of unsuccessful right IJV catheterization due to malformation of the right IJV draining to the ipsilateral SV. The importance of reporting this case is that to the best of our knowledge, this malformation has not been previously described.…”