(Mis)placed central venous catheter in the left superior intercostal vein

Padovan, Ranka Štern; Paar, Maja Hrabak; Aurer, Igor

doi:10.2478/v10019-010-0043-7

Cited by 13 publications

(19 citation statements)

References 10 publications

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“…Dynamic radiograph while injecting small volume contrast into central venous catheter port can help in delineating venous anatomy and confirm tip location. Padovan et al [6] and Vahid et al [7] used computed tomography (CT) to confirm the malposition of the catheter into left superior intercostals vein. Computed tomography (CT) may be of use to confirm the tip location, however, routine use cannot be recommended for confirming catheter tip due to concerns of high radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Accidental Cannulation of Left Superior Intercostal Vein: A Rare Instance of Central Venous Catheter Malpositioning

Rathod¹,

Sharma²

2018

JCR

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Background: Central venous catheter (CVC) placement plays an important role in the management of critically ill patients. Complication rates have been reduced with the use of image guidance for their placement. Sometimes, particularly in emergency situation or due to lack of image guidance accidental malpositioning of these catheters can occur further adding to morbidity of the critically ill patients. Case Report: Herein we report a case of CVC placement into left superior intercostal vein during a left sided internal jugular vein (IJV) CVC placement. Conclusion: High index of suspicion along with thorough knowledge of anatomy is required to early detect malposition of central venous catheter.

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Section: Discussionmentioning

confidence: 99%

Accidental Cannulation of Left Superior Intercostal Vein: A Rare Instance of Central Venous Catheter Malpositioning

Rathod¹,

Sharma²

2018

JCR

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“…Insertion of a CVC should be within a large‐calibre vein with sufficient flow to tolerate infusion for example subclavian, brachiocephalic, superior vena cava . However, malposition of the CVC can occur.…”

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confidence: 99%

“…However, malposition of the CVC can occur. Review of the literature resulted in three previous reports of a left internal jugular vein CVC being introduced into the left SIV . The use of a post‐insertion CXR for confirmation of CVC position is routine.…”

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confidence: 99%

Unsuspected path: a central venous catheter insertion

Agostinho

Robinson

Yan

2015

ANZ Journal of Surgery

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A central line is an intravascular device or catheter that terminates at or close to the heart in one of the great vessels, and is used to provide temporary or long-term vascular access for the delivery of pharmacotherapy, total parenteral nutrition and/or regular blood sampling. 1 A 58-year-old woman presented to the emergency department with a 1-week history of malaise, anorexia, bilateral flank pain and decreased colostomy output, on a background of Crohn's disease with multiple resections.On examination she appeared cachectic and distressed, but alert and orientated. She was febrile (38.4°C), normotensive (systolic 115, diastolic 63 mmHg), tachypnoeic (20/min), but saturating well (97%) on ambient air. Biochemical investigations revealed an acidosis (pH 7.10), acute kidney injury (AKI) (creatinine 247 μmol/L), a normal white cell count (9.3 × 10^9/L) and elevated C-reactive protein (182.9 mg/L). She was prepared for intensive care unit admission for ongoing management.A left internal jugular three lumen central venous catheter (CVC) was inserted utilizing ultrasound to minimize complications. Two passes were required for insertion with a note of 'difficulties passing the wire beyond valve'. A post-insertion chest radiograph (CXR) was performed to confirm the CVC's position (Fig. 1). This revealed that the CVC was not in the desired location (cavo-atrial junction) and that it may have entered the descending aorta. A lateral CXR was performed revealing the CVC taking a posterior course in the left hemithorax (Fig. 2). The CVC was flushed and aspirated without any documented difficulty. Blood was aspirated from the CVC for blood gas analysis and results suggested venous placement (pO 2 52 mmHg, pCO2 43 mmHg) when compared with blood gas analysis from a peripheral arterial sample (pO2 116 mmHg, pCO2 42 mmhg). Connection of the CVC to a transducer produced a venous trace. Because of AKI a contrast study (computed tomography (CT) or venogram) was avoided to minimize renal insult. A non-contrast CT scan was performed, that mapped the CVC travelling through the left internal jugular vein, into the left innominate vein and down one of its inferior tributaries -the left superior intercostal vein (SIV) (Fig. 3). The left SIV is responsible for draining the superior left posterior hemithorax and is a component of the azygous venous system. It is formed by the union of the second to fourth left posterior intercostal veins and courses superiorly to the left of the midline, arches superiorly lateral to the aortic arch to drain into the left innominate vein. 2 The decision was made to remove the CVC, and was performed successfully without negative sequalae.Insertion of a CVC should be within a large-calibre vein with sufficient flow to tolerate infusion for example subclavian, brachiocephalic, superior vena cava. 3 However, malposition of the CVC can occur. Review of the literature resulted in three previous reports of a left internal jugular vein CVC being introduced into the left SIV. 3-5 The use of a post-insertion CXR fo...

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“…About 75% of the left superior intercostal veins communicate with the accessory hemiazygos vein which drains between left fifth and eight posterior intercostal veins. [3] The left superior intercostal vein may become the tributary of the persistent left superior vena cava. If the diameter of the left superior intercostal vein exceeds 4.5 mm, it can be easily identified on the upright posteroanterior chest radiograph.…”

mentioning

confidence: 99%

“…[2] The differential diagnosis of a dilated left superior intercostal vein includes mediastinal masses, lymphadenopathy, and aneurysms or dissection of the aorta. [3] A 44-year-old male was referred with a thrombus on his left common carotid artery which was detected through cervical computed tomography. He had a history of parotid gland resection and presented with a left-sided craniofacial tumor and multiple metastases on his both lungs.…”

mentioning

confidence: 99%