Successful removal of a malpositioned hemodialysis catheter into the aortic arch

Ministernotomy repair of inadvertent proximal right subclavian artery injury following right internal jugular central venous catheter insertion

A man in his 60s was referred for urgent coronary artery bypass grafting (CABG) procedure following acute coronary syndrome. After induction of general anaesthesia, right jugular venous catheterisation under two-dimensional ultrasound guidance was planned as part of perioperative management. While obtaining vascular access, the pulsatile flow was noted once the dilator was inserted, having to abandon the procedure and immediately apply manual pressure. CT angiogram showed proximal right subclavian artery injury with active contrast extravasation and resultant large haematoma in the neck. The patient underwent urgent exploration of the injured vessel through a J-shaped ministernotomy, and primary repair of the artery was performed. The patient recovered from the procedure without any complications. He continued to stay in the hospital for a few days, afterwards, he underwent the initially planned CABG surgery. He was discharged home on day 5 after surgery without further concerns.

Where is that hemodialysis catheter (superior vena cava or aorta)? A case of intraarterial catheter placement

We present a case of a previously unrecognized intraarterial placement of a central venous catheter (CVC)-in this case, a large-bore hemodialysis catheter in an 82-year-old woman. CVC insertions have become a common practice in hospitals due to a variety of indications, and tunneled CVCs still remain an important form of access in patients with end-stage renal disease. Intraarterial puncture is a common complication during CVC insertion, while intraarterial (mis)placement is fairly uncommon and if unrecognized can lead to significant morbidity and mortality.