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Case Report
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| An unusual case of a misplaced left internal jugular vein catheter | ||||||
| Sunil Rangarajan1, Sunad Rangarajan2, Lindsey Smith Hinton3 | ||||||
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1MBBS, Postdoctoral Scholar, University of Alabama at Birmingham, Birmingham, AL.
2MD, Fellow, Pulmonary and Critical Care, University of Alabama at Birmingham, Birmingham, AL. 3MD, Resident, Internal Medicine, University of Alabama at Birmingham, Birmingham, AL. | ||||||
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| How to cite this article: |
| Rangarajan S, Rangarajan S, Hinton LS. An unusual case of a misplaced left internal jugular vein catheter. International Journal of Case Reports and Images 2013;4(10):567–570. |
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Abstract
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Introduction:
Most often, cannulation of the right internal jugular vein (IJV) is preferred over the left IJV. However, in situations where the right IJV cannot be utilized for accessing the central circulation, as in our case, the left IJV is used. Cannulation of left IJV has additional risks due to the anatomical variations. Despite the use of ultrasound guidance, anatomical variations and tortuous course of the left IJV make cannulation of the left IJV more prone to the failure of cannulation or malposition of the cannula leading to catastrophic complications.
Case Report: A 63-year-old female with multiple comorbidities presented with progressive shortness of breath and mild respiratory distress due to bibasilar pneumonia. Despite aggressive management of her pneumonia, she continued to deteriorate and became increasingly hypoxemic, hypotensive with abnormal renal functions necessitating medical intensive care treatment and continuous hemodialysis. As she had a chemo-port in her right subclavian vein, it was determined to avoid insertion of the dialysis catheter in her right IJV. An attempt was made to insert the catheter in her left IJV under ultrasound guidance. The catheter was inserted without any perceived resistance. Blood withdrawn from the ports was however, bright red, and gas analysis revealed arterial blood values. A bed side X-ray revealed that the catheter was in the heart. Conclusion: This is the first reported case where the tip of the cannula was in the left atrium. Despite the use of ultrasound guidance, the anatomical variations and the tortuous course of the left internal jugular vein make its cannulation more prone to failure or malposition of the cannula leading sometimes to catastrophic complications. This case reinforces studies which have shown that even with ultrasound guidance, left internal jugular vein cannulation is fraught with higher risk of complications. | |
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Keywords:
Central vein cannulation, Internal jugular vein (IJV)
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Author Contributions
Sunil Rangarajan – Conception and design, Acquisition of data, Drafting of the article, critical revision of the article, Final approval of the version to be published Sunad Rangarajan – Conception and design, acquisition of data, Drafting of the article, Critical revision of the article, Final approval of the version to be published Lindsey Smith Hinton – Acquisition of data, Drafting of the article, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© Sunil Rangarajan et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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