Two Cases of Malpositioning of Internal Jugular Central Venous Catheters: A Review of Literature and Current Treatment Recommendations

Abstract

Percutaneous central venous catheterization, despite ultrasound guidance, is known to carry significant risks. While central venous catheters are widely used in clinical practice, they are also associated with various complications, including incorrect positioning during insertion. Arterial puncture is a well-recognized complication, and although unintended subclavian or carotid artery cannulation is rare, it can lead to serious consequences. We present two cases, in which a dual-lumen, non-tunneled temporary hemodialysis catheter was inadvertently inserted into the left common carotid artery and in the left innominate vein.

Keywords: arterial puncture of cvc; complications of cvc placement; cvc malposition management; intraarterial placement of cvc; malposition of cvc.

Figure 1. a. A right-sided central venous catheter takes an erroneous turn and appears to terminate in the left innominate vein (black arrow); b. Schematic diagram depicting the jugular and carotid anatomy, the black arrow indicates the location of the malpositioned catheter tip

Source: Major Veins of the Heart 2 by ShannaBear on DeviantArt [4]

Figure 2. a (white arrow): The outlines of the common origin of the innominate artery and the left common carotid artery are delineated in red; b (black arrow): The innominate artery; c (blue arrow): The left common carotid artery

Figure 3. a. Right internal jugular central venous catheter in situ with its tip projecting into the region of the mid-left innominate vein (black arrow) b. The right jugular catheter tip was seen within the innominate vein (white arrow).

Figure 4. A: The catheter tip appears to be in the left innominate vein (black arrow); B: The catheter tip seemed to be in the innominate vein but was found to be in the left common carotid artery (red arrow)