Successful removal of a malpositioned hemodialysis catheter into the aortic arch

Minimally invasive approach to managing brachiocephalic trunk cannulation complicating central venous catheterization: a case report

BACKGROUND

Central venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment.

CASE PRESENTATION

A 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient's vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient's continued stability.

CONCLUSION

This case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure's accuracy and safety.

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.