IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Malpositioned right internal jugular vein catheter

Case contributed by Jayanth Keshavamurthy
Diagnosis probable

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.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.