A rare malposition of the central venous catheter

Cannulation of the Internal Mammary Vein With a Single-Lumen Infusion Catheter in a Patient With Portal Hypertension: A Case Report

We present a central venous catheter misplacement case. A left internal jugular vein percutaneous introducer was inserted for fluid resuscitation with a single-lumen infusion catheter placed through the lumen for medication infusions. Placement was performed under ultrasound guidance, with confirmation of the wire within the venous lumen. Radiographs suggested that the introducer had perforated the innominate vein. Contrast was injected through the single-lumen infusion catheter and showed cannulation of the left internal mammary vein. The link between portal hypertension and increased risk of central line misplacement as well as diagnosis and potential methods to avoid this rare complication are discussed.

Persistent left superior vena cava: diagnosed by bedside echocardiography in a liver transplant patient: a case report

In most cases, persistent left superior vena cava (PLSVC) is asymptomatic and discovered accidentally. This case involves a 43-year-old male who underwent an emergency cadaveric liver transplantation. Postoperatively, the left internal jugular vein was cannulated using a sono-guided Seldinger technique in the intensive care unit. But the chest X-ray showed that the catheter followed the left paramediastinal course instead of crossing midline to the right to enter the superior vena cava. In consideration of the patient's status, an intra-arterial or extra-vascular placement could be excluded. For a diagnosis, we performed a bed-side transthoracic echocardiography with an agitated saline micro-bubble test. When agitated saline was injected through the catheter, the coronary sinus was initially opacified, and then the right atrium followed. In conclusion, we were able to make a diagnosis of PLSVC by a bedside test without radiation exposure.

Noncardiac entrapment of a pulmonary artery catheter during heart transplantation: inadvertent cannulation and perforation of the internal thoracic vein

Placement of a central venous catheter into an internal thoracic vein occurs in approximately 2% of all catheterizations. A case in which a pulmonary artery catheter was trapped within the internal thoracic vein during orthotopic heart transplantation is presented.

Rare malposition of a central venous catheter into the left internal mammary vein in a liver transplantation patient

We report a rare malposition of a central venous catheter in a liver transplantation patient which occurred during an intensive care period. The waveform of central venous pressure was aberrant after connecting the catheter to the pressure kit transducer. It was misplaced into left internal mammary vein confirmed by thoracic computed tomography. Significant engorgement of the left internal mammary vein may have been the cause of this rare malposition.

A rare malposition of the thoracic venous catheter introduced via the left internal jugular vein

A rare malposition of central venous catheter in the left superior intercostal vein is described. The diagnostic features and the possible ways to prevent this complication are discussed.

Cardiac tamponade associated with a peripheral vein central venous catheter

We present a case of cardiac tamponade associated with placement of a central venous catheter (CVC) via a peripheral vein in a 14-year-old girl with idiopathic scoliosis undergoing corrective surgery. A number of complications have been described in association with CVC misplacement. Sporadic cases of cardiac tamponade from this have been reported, but the actual incidence is unknown. Death from cardiac tamponade attributed to CVCs ranges from 65 to 100%. In our patient, cannulation of the pericardiophrenic vein was probably the cause of cardiac tamponade, based on radiological evidence that the initial location of the catheter was near the right atrium and possibly at the outlet of the pericardiophrenic vein. The catheter could have advanced into the vein and then to the pericardial sac with postural changes. The acute clinical course of cardiac tamponade in our patient had potentially lethal hemodynamic repercussions. The main diagnostic test for this condition is echocardiography and the only effective treatment is drainage of the pericardial effusion. Echocardiography should be performed before pericardiocentesis except in life-threatening situations or high clinical suspicion. Although they are rare, it is important to be aware of the potential for CVC complications.

Unusual positioning of a central venous catheter

Central venous cannulation, with or without a flow-directed pulmonary artery catheter, is commonly performed in patients undergoing cardiac surgery to measure central filling pressure and cardiac output, and to administer medications and fluids. The complications of central venous cannulation are numerous and include malposition, arterial puncture, pneumothorax, hemothorax, chylothorax, extravasation of infusate, thrombophlebitis, and infection. We describe a single-lumen catheter that was placed through the hemostatic valve of a 9F percutaneous introducer, which inadvertently entered the left internal mammary (internal thoracic) vein. The current case is unique in that it was diagnosed by visualization of the catheter during surgical dissection.

Left mediastinal central line malposition--a case report

Central venous line malpositioning in the left mediastinum is a rare event. A case of left superior intercostal vein central venous line placement is reported. Chest radiographs, especially lateral views and contrast studies, are useful for position evaluation. Catheter removal is prudent although the purpose of the catheter and the symptomatology can dictate further management of the malpositioned catheter.

Hydrothorax After Inadvertent Placement of a Central Venous Catheter in the Left Pericardiophrenic Vein

Angiography has a central role In both diagnosis and therapy of traumatic vascular injuries from blunt and penetrating mechanisms. Angiography is considered the “gold standard” for establishing the presence of vascular injury, but precise indications and appropriate timing of angiography in certain clinical situations, such as proximity injury to the extremities or penetrating neck injuries, remain controversial. We consider the role of angiography in the diagnosis of major arterial injury in the thorax, selective use of diagnostic and therapeutic angiography for intraabdominal trauma, identification and control of pelvic hemorrhage, and detection of vascular injury of the head, neck, and extremities.

Blind cannulation of the left pericardiophrenic vein: an unusual cause of diaphragmatic pacing

Diaphragmatic stimulation as a complication of cardiac pacing due to right ventricular perforation of an endocardial lead or penetration of a screw-in lead along the right atrial free wall, adjacent to the right phrenic nerve, has previously been described. A case of diaphragmatic pacing due to inadvertent insertion of a temporary pacing lead into the left pericardiophrenic vein via the left internal jugular vein is presented and anatomical considerations are discussed.

Interpleural placement of central venous catheter. Failure of preventive practices

An attempt to access the central venous circulation in a patient with a persistent left pleural effusion resulted in positioning the catheter within the pleural space. Chest roentgenograms with injection of contrast material revealed catheter location. Compliance with standard preventive practices may not assure correct placement of a central venous catheter via the internal jugular route in a patient with a hemothorax or effusion of unknown composition.