Central Venous Catheter Malposition: Two Case Reports
Introduction: Unintended vessel advancement during central venous catheter (CVC) insertion is a rare but serious complication. To reduce the complications while CVC placement, the practitioner should be experienced. After the placement it is required to verify correctness.
• Case 1: A 65-year-old male patient who returned as hypotensive after cardiopulmonary resuscitation was planned with CVC insertion formonitoring central venous pressure, fluid replacement and inotropic support. As the patient’s hemostatic parameterswere normal, catheter was placed into the right subclavian vein. Posterior-anterior chest radiograph(CR) was used to confirm catheterization site. It was found that catheter tip was not in normal position, right internal jugular vein(IJV) was directed and twisted in two places.
• Case 2: A 64-year-old patient with respiratory distress was conscious of consciousness. The patient’s hemostasis parameters were normal and was placed central catheter into right internal jugular vein (IJV). It was seen by the CR that catheter tip was not in the correct position and it was directed to the right subclavian vein.
Discussion: One of the most common complications during CVC placement is malposition of the catheter. Placing a CVC is an invasive procedure and it should be remembered that various complications may develop during or after the placement. Moreover, practitioners should remember that malposition may not be noticed if no imaging and checking methods are used during CVC administration. It is important that the accuracy of the position of the CVC should be confirmed with post-procedure CR. Thus, any complications that require emergent intervention like malposition or pneumothorax can be detected early.
Eurasian J Critical Care. 2019;1(2):91-94 EJCC