Central Venous Pressure Catheter Malposition from Right Internal Jugular Vein into the contralateral innominate vein: A Rare complication: Research Article

Vishnu Datt; Vijay Agarwal; Priyanka; Divya; Arpan Sonkar; Rashmi Sharma; Bhavini Chawla

doi:10.58372/2835-6276.1321

Authors

Vishnu Datt
Vijay Agarwal
Priyanka
Divya
Arpan Sonkar
Rashmi Sharma
Bhavini Chawla

DOI:

https://doi.org/10.58372/2835-6276.1321

Keywords:

CVP line, catheter malposition, left innominate vein, OP-CABG surgery, RIJV

Abstract

CVCs are inserted for many different indications in cardiac surgery and ICU. These include administering drugs (anaesthetic and vasoactive agents, antibiotics, chemotherapy), monitoring central venous pressure (CVP)or hemodynamic monitoring, measurement of central venous oxygen saturation (SCVO2), renal replacement therapy, total parenteral nutrition, poor peripheral venous access, cardiac catheterization, and transvenous cardiac pacing. Despite the level of skill of the operator and the use of ultrasound guidance, CVC placement can result in CVC malposition.

Easy and uncomplicated catheterisation, free aspiration of blood and monitoring of catheterisation do not guarantee correct placement of the IJV catheter. Though, placement of a catheter through the RIJV is associated with the lowest incidence of malposition.

Ultrasound, ECG guidance, real-time X-ray imaging, surgical confirmation either by palpation in SVC or visualized in the RA, and saline injection test are definite confirmation and dramatically increase the successful placement of needles, guidewires, and catheters, but significant numbers of catheter misplacements can still occur, particularly if operators are not fully proficient in such techniques. A case of RIJV inserted CVP catheter malposition has been reported in 57 years old, 61 kg and 155cm height with short and thick neck patient presented with triple vessel CAD posted for OP-CABG surgery. Postoperative Chest X-Ray revealed a right sided CVP line catheter malposition in the contralateral innominate vein. Even though, the malposition of the CVP catheter inserted via RIJV is less frequently reported.

References

Trerotola SO, Kuhn-Fulton J, Johnson MS, Shah H, Ambrosius WT, Kneebone PH. Tunneled infusion catheters: Increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access. Radiology. 2000;217:89–93.

Bourquelot P. Vascular access for haemodialysis. Nephrol Ther. 2009;5:239–48.

Ruesch S, Walder B, Tramèr MR. Complications of central venous catheters: Internal jugular versus subclavian access – A systematic review. Crit Care Med. 2002;30:454–60.

Madan Mohan Maddali, MD⁎ madanmaddali@hotmail.com ∙ Karima Rashid Salim Al Aliyani, MD† ∙ Nishant Ram Arora, MD⁎ ∙ Panchatcharam Murthi Sathiya, MSc.‡ Central Venous Catheter Tip Malposition After Internal Jugular Vein Cannulation in Pediatric Patients With Congenital Heart Disease.Journal of Cardiothoracic and Vascular Anesthesia,Aug 2022. Volume 36, Issue 8, 2483 - 2487.

Shannon D. Central venous catheter-induced pericardial effusion in a neonate: a case study and recommendations for practice. Neonatal Netw. 2014 Nov-Dec;33(6):341-8.

Yin-Ju Chen1,2, Shih-Chieh Chung2,3,4, Yen-Chin Liu2,3. Delayed Malposition of Central Venous Catheter Induced Mediastinum Hematoma With Innominate Vein Perforation. Asian Journal of Anesthesiology 56(2): 66-69, Jun. 2018.

Roldan CJ, Paniagua L. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction. West J Emerg Med. 2015 Sep;16(5):658-64.

Gibson F, Bodenham A. Misplaced central venous catheters: applied anatomy and practical management. Br J Anaesth. 2013;110(3):333–346.

Coskun D, Mahli A, Oncul S, Ilvan G, Dalgic A. Malposition of subclavian vein catheter inserted through indirect technique in a pediatric liver transplantation: A case report. Cases J. 2009;2:7998.

Chashamjot Bawa1, Laveena Dabla2, Jyoti Raina3, Himank Chadha.Malpositioning of Central Venous Catheter from Right Internal Jugular Vein into Ipsilateral Vertebral Vein: A Rare Phenomenon Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03.

Tanrikulu N, Haspolat A, Koprulu AS. Very rare malposition of central venous catheter in cardiac surgery patients. Cardiovasc J Afr. 2023 Nov-Dec 23;34(5):321-324.

P.M. Shah, S.C. Babu, A. Goyal, R.B. Mateo, R.E. Madden.Arterial misplacement of large-caliber cannulas during jugular vein catheterization: case for surgical management.J Am Coll Surg, 198 (6) (2004), pp. 939-944.

Aaron Miller, Daniel W. Griepp, Ralph Rahme. Inadvertent through-and-through internal jugular vein penetration and intracarotid placement of a central venous catheter: Microsurgical retrieval technique and operative video, Annals of Vascular Surgery - Brief Reports and Innovations,Volume 2, Issue 1,2022,100044,ISSN 2772-6878.

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;100:21-4.

Anish M Joshi, Guruprasad P Bhosale, Geeta P Parikh. Optimal positioning of right- sided internal jugular venous catheters: Comparison of intra-atrial electrocardiography versus Peres' formula. Ind J Crit Care 2008;12:10-14.