Malpositioned right internal jugular vein catheter

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Right internal jugular vein catheter placement, position and evaluate for pneumothorax.

Patient Data

Age: 40 years
Gender: Male

Right lateral lower neck approach central catheter with the tip extending past the midline and approximately overlying the aortic arch worrisome for an intra-arterial position. Follow-up with CT chest is warranted to evaluate catheter position.

Case Discussion

Right internal jugular and subclavian catheters should not cross the midline. Left  internal jugular and subclavian catheters should cross midline unless you have a left SVC.

A blood gas analysis was performed at the bedside. This confirmed an inadvertent cannulation of the carotid artery. This is a potentially devastating complication if not recognized quickly. If there is any doubt, the needle’s location can be alternately confirmed by pressure transduction. If a carotid artery is cannulated, vascular surgery should be consulted. Inadvertent dilation and cannulation of the carotid artery is associated with severe complications such as carotid thrombosis and acute stroke.

In this case, no CT was done and the catheter was removed without any complications.

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Case information

rID: 56505
Case created: 5th Nov 2017
Last edited: 8th Nov 2017
Inclusion in quiz mode: Included
Institution: Augusta University

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