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. 2023 Sep 6;9(1):58.
doi: 10.1186/s40981-023-00649-1.

Inadvertent catheter misplacement into the subclavian artery during ultrasound-guided internal jugular venous catheterization: a case report

Tomoki Kohyama  1 , Keisuke Fujimaki  2 , Hiroki Sasamori  3 , Joho Tokumine  4 , Kiyoshi Moriyama  5 , Tomoko Yorozu  5
Affiliations

Inadvertent catheter misplacement into the subclavian artery during ultrasound-guided internal jugular venous catheterization: a case report

Tomoki Kohyama et al. JA Clin Rep. .

Abstract

Background: Ultrasound-guided central venous catheterization has become a standard procedure. However, mechanical complications are still reported.

Case presentation: An 85-year-old woman presented with coagulopathic bladder tamponade. Ultrasound-guided right internal jugular venous catheterization was planned because of difficult peripheral venous access. A guidewire was advanced through a needle inserted at the midpoint of the right carotid triangle. The guidewire was identified in the short axis, but not in the long-axis ultrasound view, leading to inadvertent insertion of the catheter into the right subclavian artery through the internal jugular vein. Stent graft insertion was performed for perforation closure. The patient exhibited no symptoms of cerebral ischemia following stent graft insertion.

Discussion: This case demonstrated that the needle-sticking site should not be placed close to the clavicle for ultrasound-guided internal jugular venous catheterization, as it may not confirm the position of guidewire in the long-axis ultrasound view.

Keywords: Guidewire; Low approach; Mechanical complication; Ultrasound-guided internal jugular venous catheterization.

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Conflict of interest statement

J. T. is a technical adviser of the Cardinal Health K.K. (Japan) and has done an ultrasound-guided technical training course held by the company. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Postprocedural chest roentgenography. The catheter tip appears to overlap the shadow of the trachea where the right brachiocephalic vein or aortic arch exists
Fig. 2
Fig. 2
Catheter location with three-dimensional angiography. The catheter (green color) is inserted into the right subclavian artery through the right internal jugular vein. The tip of the catheter is inserted into the right brachiocephalic artery
Fig. 3
Fig. 3
Classification by needle-sticking site for Sedillot’s triangle. In the classification of anatomic landmark techniques by needle-sticking site of Sedillot’s triangle (white dashed triangle), there are two types: high approach (H) and low approach (L). The preferred sticking site in the high approach is the apex (white circle) of the Sedillot’s triangle
Fig. 4
Fig. 4
Schematic representation of cervical and thoracic veins for possible misplacement of central venous catheters. a Frontal view. b Lateral view showing ① right internal thoracic vein, ② left internal thoracic vein, ③ pericardiophrenic vein, ④ azygos vein, ⑤ right inferior thyroid vein
See this image and copyright information in PMC

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