Very rare and serious complication of central line insertion

Abstract

Central venous catheter (CVC) placement is indicated for various therapeutic and diagnostic purposes. However, it is important to ensure its proper placement. A CVC malposition is associated with number of recognized complications, some of which can be fatal. Case: In a 27 year female admitted in ICU with history of seizures and oral bleed with stable vitals, 7Fch subclavian CVC was inserted. She had progressive dyspnea, chest pain and hypotension. Although chest X-ray showed correctly positioned CVC, CECT chest showed it was entering SVC, traversing along its medial wall and reaching between SVC and aorta and entering in the right atrium. Also atelectic fluid in oblique fissure, bilateral pleural effusion and small pocket of air in anterior mediastinum with minimal mediastinal high attenuation collection was seen. This was removed and patient was under observation for 24 hours, after which she was shifted to ward. Conclusion: Therefore location of the catheter must be verified by radiological methods. Also real-time ultrasound reduces the number of complications associated with the technique.