Volume 47, Issue 4 December 2023 JVU 474-204 | Catheter Misplacement Following Subclavian Vein Catheterization Under Ultrasound Guidance: An Infrequent and Unusual Malposition-474-204

474-204

Pdf Summary

This case report discusses a rare and unusual malposition of a central venous catheter inserted through the right subclavian vein in an obese patient who was scheduled for carotid endarterectomy. The catheter was found to be forming a "figure of U" in the ipsilateral subclavian vein. Despite the use of ultrasound guidance, the course of the guidewire could not be visualized due to a poor ultrasound window. The catheterization was initially successful, but complications arose later, including loss of the central venous pressure waveform and resistance to blood aspiration and intravenous fluid flow. A postoperative chest X-ray confirmed the malposition of the catheter. <br /><br />The report emphasizes the importance of visualizing the guidewire tip during central venous catheterization to prevent catheter malposition. It suggests several learning points to improve the procedure, such as orienting the bevel of the introducer needle caudad before puncture, orienting the J-tip of the guidewire caudad during insertion, visualizing the ipsilateral internal jugular vein to avoid guidewire entry, and using echocardiography to direct the guidewire tip into the superior vena cava-right atrium junction. Proper orientation and visualization of the guidewire tip can reduce the incidence of catheter malposition.<br /><br />Overall, the case report highlights the limitations of ultrasound guidance in guiding the final position of the guidewire and preventing catheter malposition. It underscores the importance of incorporating additional techniques, such as echocardiography, to improve the accuracy of central venous catheterization. Further research and awareness are needed to enhance patient safety in this procedure.

Keywords

central venous catheter

malposition

right subclavian vein

obese patient

carotid endarterectomy

ultrasound guidance

guidewire

ipsilateral subclavian vein

central venous pressure waveform

chest X-ray