Parenteral Nutrition Solution in Cerebrospinal Fluid in Preterm Newborn – a Case Report and Review of the Literature

Central venous catheters misplaced in paraspinal veins: A systematic literature review based on case reports

BACKGROUND

Paraspinal vein misplacement is an uncommon complication of central venous catheterization via lower extremities, most of which have been reported in case reports.

AIM

To determine the clinical characteristics of paraspinal vein misplacement.

DESIGN

This was a systematic review.

METHODS

A systematic literature search in the PubMed, EMBASE, Scopus, and Web of Science databases was performed from their inception to 18 June 2019. Case reports and small case series describing central venous catheter misplacement in the paraspinal vein were included. Data on the catheterization procedure, catheter tip position, complications, and radiographic features of misplacement were extracted.

RESULTS

Thirty studies with a total of 36 patients were included. The ascending lumbar vein accounted for the majority of misplacements (n = 30), followed by the lumbar vein (n = 4), iliolumbar vein (n = 1), and vertebral venous plexus (n = 1). Six patients had eventful catheterization procedures. Twenty-six patients experienced misplacement-induced complications, of whom seven died. The most common complications included cerebrospinal fluid abnormalities, neurological symptoms, and deteriorated respiration. Among the entire case cohort, the onset of complications was the primary sign that alerted medical staff to misplacement (n = 23). The typical radiographic characteristics were posterior deviation of the catheter course overlapping with the spine on lateral X-rays and a bend, kink, or hump in the catheter course on anteroposterior X-rays at the L4 to L5 levels.

CONCLUSIONS

Nurses should be aware of this particular complication if a patient who has undergone catheterization via a lower extremity presents deterioration of neurological function and respiration.

RELEVANCE TO CLINICAL PRACTICE

Lateral X-ray radiography is an effective method to verify misplacement and is recommended as routine practice during catheterization via lower extremities.

A peripherally inserted central catheter misplacement into lateral thoracic vein: A case report

INTRODUCTION

Central venous catheter applications and complications are closely related to the tip position. Previous studies have reported some rare cases of catheter misplacement. Here, we report a case of misplacement of a peripherally inserted central catheter into the lateral thoracic vein.

CASE REPORT

A 56-year-old cancer patient underwent placement of a peripherally inserted central catheter through the left basilic vein under ultrasound-guided puncture. The catheterisation procedure was uneventful, so the catheter was believed to be in the superior vena cava. However, the post-anterior chest X-ray image revealed that after the catheter advanced towards the axilla, it turned downwards and outwards in the direction of the left lateral thoracic region, with the projection of the catheter tip giving the appearance of termination in the subcutaneous tissue of the lateral thoracic wall on the two-dimensional image. The catheter was then repositioned in the distal superior vena cava.

DISCUSSION

Peripherally inserted central catheters can be potentially misplaced into the lateral thoracic vein because these catheters can pass through the orifice of the lateral thoracic vein which flows into the axillary vein. Some pathological cases and clinical conditions can cause dilatation of the lateral thoracic vein, which increases the probability of catheter misplacement. Three principles were proposed to avoid this rare complication: a comprehensive review of the patients' medical history, real-time image-guided catheterisation and routine radiographic identification of the tip position.