Bent peripheral venous catheter inserted using ultrasound-guided dynamic needle tip positioning

Herein, we report the case of a 2-year-old boy in whom a bent peripheral venous catheter was inserted using ultrasound-guided dynamic needle tip positioning via a short-axis out-of-plane approach. The peripheral venous catheter appeared to be successfully inserted into the cephalic vein in the forearm using dynamic needle tip positioning via a short-axis out-of-plane approach. However, after removing the inner needle, no blood return was confirmed. The removed catheter was noted to be bent at approximately one-third of the catheter length from the tip. A large change in the puncture angle during dynamic needle tip positioning for a deeply located vein might have caused this bend. Deeply located veins are not targeted when a blind puncture technique is used, as they are not visible and palpable. They can be visualized by ultrasonography and can be targeted using DNTP; however, the catheter may bend. Clinicians should be aware of this issue and, therefore, they are suggested to ensure that the puncture angle is not too steep and use a long length catheter; in addition, very deep veins should not be targeted.