tipology:letter

numero rivista e pagine: HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2011; 3(2): 135-136
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A case of radiological dilemma after a central venous catheter positioning

Authors: S. Romagnoli*1

Department of Cardiac and Vascular Anesthesia and Post-Surgical Intensive Care Unit, Careggi Hospital, Florence, Italy

Corresponding author: * Corresponding author:
Dr. Stefano Romagnoli
Department of Heart and Vessels
Cardiac and Vascular Anesthesia and
Post-Surgical Intensive Care Unit Careggi Hospital
Viale Morgagni, 85 - 50134 Florence, Italy


E-mail: romagnoliste@tiscali.it

Complication rates associated with attempted central venous catheter (CVC) insertion were reported to be as high as 10% and, among them, the displacement into a thoracic vein was rarely described [1].
An ultrasound-guided CVC was placed via left trans-jugular access in a patient with a prior Bentall operation for type A aortic dissection.
Due to the impossibility of collecting blood from the three lumens of the CVC, a chest X-ray was performed with the aim at checking the placement of the CVC.
The radiologist suspected the displacement of the catheter into the aorta via a carotid puncture (Figure 1).

 

 

Figure 1

Chest X-ray that shows the central venous catheter in uncertain position.

 

Then, an angiography was performed which showed the displacement of the CVC into the left internal thoracic vein (Figure 2).

 

 

Figure 2

Angiographic examination that shows the placement of the central venous catheter in the left internal thoracic vein.

 

The catheter was repositioned in the proper position without a new puncture under angiographic guidance (Figure 3).

 

 

Figure 3

Correct central venous catheter placement.

 

The correct position of the catheter was necessary for measuring the central venous oxygen saturation and an appropriate value of central venous pressure.

 

References

  1. Atkinson P, Boyle A, Robinson S, Campbell-Heweson G. Should ultrasound guidance be used for central catheterization in the emergency department? Emerg Med J. 2005; 22: 158-164.

Cite as: Romagnoli S. A case of radiological dilemma after a central venous catheter positioning. HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2011; 3(2): 135-136

 

Source of Support: Nil.

 

Conflict of interest: None declared.