Malpositioned central venous line in a vertebral vessel

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

Post-RTA case with collapse, lost consciousness and multiple fractures, transferred to ED for resuscitation then intubated and admitted to the critical care unit.

Patient Data

Age: 25 years
Gender: Male

An abnormally seated central venous line along the left vertebral vessel course along transverse foramina of the cervical vertebrae.

Multiple fractures were seen along the left vertebral transverse processes as well as the visualized right rib segment.

Pneumothoraces were noted, larger on the right.

Oral ETT and NGT were also noted.

Case Discussion

Accidental abnormal placement of a central venous catheter is an uncommon but serious complication.

Ultrasound-guided CVC insertion is proposed to reduce the number of complications and to increase the safety and quality of CVC placement.

Careful assessment of line position on routine post-insertion chest x-ray is vital to confirm adequate placement.

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