Misplacement of an internal jugular hemodialysis catheter due to stenosis caused by previous short-term catheterization
Prakash K Dubey
Department of Anesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, India
Dual lumen hemodialysis catheters are usually inserted via the right internal jugular vein (IJV). Subclavian vein (SCV) is generally avoided to prevent thrombosis or narrowing. [1] The site of stenosis caused by SCV catheter is usually near the junction of the SCV and IJV. [2]
A 30-year-old female, suffering from endstage renal disease, was in the operating room for insertion of a hemodialysis catheter. She had undergone right IJV catheterization about 45 days back. The previous catheter had remained in situ for about 15 days. The exact cause of catheter removal was not documented. As she had no clinical signs or symptoms in the upper limb or the neck suggesting any complication, it was decided to cannulate the right IJV again.
After instituting monitoring with lead II electrocardiogram, noninvasive blood pressure, and a pulse oximeter, a 12.5 Fr hemodialysis catheter (Soft-cell® PC kit, Bard Access Systems, Utah, USA) was placed uneventfully via the right IJV under local anesthesia with full aseptic precautions. Free aspiration of blood via both the lumens was attained through a 5-ml syringe. A chest radiograph was obtained postprocedure and haemodialysis was started without inspecting the X-ray film. However, a satisfactory blood flow through the hemodialysis machine could not be obtained. Gentle manipulation of the catheter and change in patient position made no difference to the flow. Meanwhile, the X-ray film revealed catheter misplacement into the ipsilateral SCV [Figure 1].
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