Central venous catheter placement: where is the tip?

Area of Science:

• Medical Procedures
• Radiology
• Neurosurgery

Background:

• Central venous catheter (CVC) insertion is a frequent bedside procedure in intensive care units.
• Internal jugular vein access is a common approach for CVC placement.

Observation:

• An 82-year-old male patient developed an unusual complication post-CVC insertion.
• Initial insertion into the internal jugular vein had no immediate complications.
• Postprocedural radiographs revealed unexpected rostral migration of the CVC.

Findings:

• Computed tomography (CT) confirmed the CVC had cannulated the jugular bulb at the jugular foramen level.
• This represents the first documented case of CVC migration from the internal jugular vein into the dural sinuses.
• The migration pathway involved the venous system extending into the cranial dural sinuses.

Implications:

• This case underscores the critical importance of postprocedural radiography after CVC insertion.
• Routine imaging can detect potentially serious malpositions and complications.
• Accurate catheter placement verification is essential for patient safety in intensive care settings.