Inadvertent insertion of a venous catheter into the internal thoracic vein: a word of caution

Abstract

Central venous catheters are widely used in clinical practice and are linked to many types of complications, including incorrect positioning at the time the catheter is fitted. Here, the authors describe a case in which a fully implantable catheter was inadvertently positioned in the right internal thoracic vein. The complication was identified when the nursing team attempted to use the catheter. The right internal thoracic vein is within the radiographic projection of the right brachiocephalic vein and the superior vena cava, simulating correct catheter placement on an anteroposterior radiograph. In cases of central catheter malfunction during the immediate postoperative period, work-up should include oblique and lateral views, to rule out the complication described here without a need for computed tomography.

Catheter misplacement from an implantable central venous access port into the internal thoracic vein: a case description

“…Lateral fluoroscopy during CVport implantation can prevent the catheter from inadvertently entering the ITV ( 10 ). Tristão et al ( 11 ) suggested lateral and oblique X-ray examination for postoperative central venous catheter dysfunction. In addition to lateral and oblique fluoroscopy, venography through the catheter is also helpful for determining the position of the catheter end.…”

Two Cases of Malpositioning of Internal Jugular Central Venous Catheters: A Review of Literature and Current Treatment Recommendations

“…Central venous catheters (CVC) serve as important conduits for the delivery of hyperosmolar drugs, chemotherapy, blood products, and parenteral nutrition [ 1 , 2 ]. They are also utilized in central venous pressure measurements, pulmonary artery catheterization, cardiac pacing, renal replacement therapy, and as an alternative venous access route when peripheral access is unavailable [ 1 , 2 ]. Common insertion sites for central catheters include the internal jugular and subclavian veins, followed by the femoral veins and superficial veins of the upper extremities [ 2 ].…”

“…They are also utilized in central venous pressure measurements, pulmonary artery catheterization, cardiac pacing, renal replacement therapy, and as an alternative venous access route when peripheral access is unavailable [ 1 , 2 ]. Common insertion sites for central catheters include the internal jugular and subclavian veins, followed by the femoral veins and superficial veins of the upper extremities [ 2 ]. Among these options, the right internal jugular vein (IJV) is often preferred due to its direct trajectory into the right atrium and reportedly lower risk of stenosis and thrombosis [ 1 ].…”

“…The placement of central venous catheters (CVC) necessitates awareness of potential complications, which typically fall into three categories: mechanical, infectious, and thrombotic [ 2 ]. Among the mechanical complications encountered during insertion, the three most common are arterial puncture, hematoma formation, and pneumothorax development [ 2 ]. Other notable complications include hydrothorax, hemothorax, chylothorax, cardiac tamponade, mediastinal hemorrhage, and mispositioning of the catheter tip [ 2 ].…”

“…Among the mechanical complications encountered during insertion, the three most common are arterial puncture, hematoma formation, and pneumothorax development [ 2 ]. Other notable complications include hydrothorax, hemothorax, chylothorax, cardiac tamponade, mediastinal hemorrhage, and mispositioning of the catheter tip [ 2 ]. Arterial puncture is a well-documented complication that occurs in 6-10 % of all IJV cannulation attempts and stands out as the most frequently encountered mechanical complication [ 3 ].…”