Late venous laceration after inappropriate placement of a left internal jugular hemodialysis catheter: a case report

Abstract

Central venous catheterization is a necessary and common method of building the circulation pathways of patients with end-stage kidney disease. Venous rupture is a severe and fatal complication of central venous catheterization. We herein present a case of slowly occurring venous rupture after reinsertion of a left internal jugular vein (IJV) catheter. A man in his early 70s was hospitalized with end-stage kidney disease. We inserted a hemodialysis catheter through the left IJV. A short section of the patient's catheter slipped out 1 month later. The original catheter was reinserted at its primary position without a guidewire. The patient reported chest pain and developed hypotension during dialysis the next day. He underwent femoral venous catheter insertion and heparin-free dialysis. The patient finally recovered and underwent regular hemodialysis using an arteriovenous fistula in the left forearm. This is the first reported case of venous laceration after repeated left IJV catheterization. Left IJV catheterization is associated with high rates of complications and should be closely monitored with the help of radiography during and after the operation. Central venous catheters should be carefully placed with clear knowledge of their direction and location to prevent serious complications.

Keywords: Complication; case report; catheterization; end-stage kidney disease; hemodialysis; venous rupture.

Figure 1.

Timeline of the case.

Figure 2.

Images at different stages of late venous laceration after inappropriate placement of a left internal jugular hemodialysis catheter. (a) Computed tomography after the first catheterization. (b) The arrow indicates the hematoma and a small amount of gas. The gas might have followed the catheter into the mediastinum during insertion. (c) The arrow indicates the hematoma. (d) Computed tomography angiography revealed the catheter in the left internal jugular vein. Part of the proximal segment of the catheter was outside the blood vessel, and the arrow indicates the hematoma. (e) Chest radiograph after the first catheterization. The arrow indicates the location of the catheter tip. (f) Chest radiograph after re-catheterization.