Central Venous Catheter Malposition: Two Case Reports

Year 2019, Volume: 1 Issue: 2, 91 - 94, 03.09.2019

Semih Aydemir Yavuz Katırcı

Abstract

Introduction: Unintended vessel advancement during central venous
catheter (CVC) insertion is a rare but serious complication.  To reduce the complications whileCVC
placement, the practitioner should be experienced. After the placement it is
required to verify correctness.

Case Presentation:

·        
Case
1: A 65-year-old
male patient who returned as hypotensive after cardiopulmonary resuscitation
was planned with CVC insertion formonitoring central venous pressure, fluid
replacement and inotropic support. As the patient’s hemostatic parameterswere
normal, catheter was placed into the right subclavian vein. Posterior-anterior
chest radiograph(CR) was used to confirm catheterization site. It was found
that catheter tip was not in normal position, right internal jugular vein(IJV)
was directed and twisted in two places.

·        
Case
2:A 64-year-old
patient with respiratory distress was conscious of consciousness. The patient’s
hemostasis parameters were normal and was placed central catheter into right
internal jugular vein (IJV). It was seen by theCR that catheter tip was not in
the correct position and it was directed to the right subclavian vein.

Discussion: One of the most common complications during CVC
placement is malposition of the catheter. Placing a CVC is an invasive
procedure and it should be remembered that various complications may develop
during or after the placement.Moreover, practitioners should remember that
malposition may not be noticed if no imaging and checking methods are used
during CVC administration.

Conclusion:It is important that the accuracy of the position of
the CVC should be confirmed with post-procedure CR. Thus, any complications
that require emergent intervention like malposition or pneumothorax can be
detected early. 

Keywords

Central venous catheter, malposition

References

• 1. McGee DC and Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-33.
• 2. Schummer W, Schummer C, Rose N, et al. Mechanical complications and malposition of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med. 2007;33(6):1055-1059.
• [3] C.-C. Chen, P.-N. Tsao, and K.-I. Tsou Yau, “Paraplegia: complication of percutaneous central venous line malposition,” Pediatric Neurology, vol. 24, no. 1, pp. 65–68, 2001.
• 4. Granata A, Figuera M, Castellino S, Logias F, Basile A. Azygos arch cannulation by central venous catheters for hemodialysis. J Vasc Access 2006;7:43-45.
• 5- Pikwer A, Bååth L, Davidson B, Perstoft I, Akeson J. The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients. Anaesth Intensive Care 2008;36:30-7.
• 6. Patel NH. Percutaneous translumbar placement of a Hickman catheter into the azygous vein. AJR 2000;175:1302-1304.7 Webb JG, Simmonds SD, Chan-Yan C. Central venous catheter malposition presenting as chest pain. Chest. 1986;89(2):309-312.
• 8. Gilner LI. The “ear-gurgling” sign. N Engl J Med. 1977;296(22):1301.
• 9. Tripathi M, Dubey PK, Ambesh SP. Direction of the J-tip of the guidewire, in Seldinger technique, is a significant factor in misplacement of subclavian vein catheter: a randomized, controlled study. Anesth Analg. 2005;100(1):21-24
• [10] K.-S. Chu, J.-H. Hsu, S.-S. Wang et al., “Accurate central venous port-a catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography,” Anesthesia & Analgesia, vol. 98, no. 4, pp. 910–914, 2004.
• [11] J.-H. Hsu, C.-K. Wang, K.-S. Chu et al., “Comparison of radiographic landmarks and the echocardiographic SVC/RA junction in the positioning of long-term central venous catheters,” Acta Anaesthesiologica Scandinavica, vol. 50, no. 6, pp. 731–735, 2006.