Hemodialysis catheter malpositioned into the mediastinum: Lessons from two cases

Area of Science:

• Nephrology
• Vascular Surgery
• Radiology

Background:

• Tunneled cuffed catheters (TCC) are essential for acute hemodialysis (HD).
• Vessel injury during HDC insertion can result in mediastinal malpositioning.
• Accurate HDC placement is critical for effective dialysis and patient safety.

Observation:

• Two cases of malpositioned hemodialysis catheters (HDC) are presented in different clinical scenarios.
• One HDC was inserted without fluoroscopic guidance, while the other utilized fluoroscopic guidance.
• Catheter malposition was suspected due to poor aspiration despite adequate infusion.

Findings:

• Chest radiography, CT, and venography confirmed various abnormal HDC positions.
• Malpositioning occurred via both right and left internal jugular vein (IJV) access.
• The findings underscore potential complications associated with HDC insertion.

Implications:

• This report adds to the understanding of malpositioned and malfunctioning HDCs.
• It highlights the importance of imaging guidance and careful technique during HDC placement.
• Awareness of these complications can improve patient outcomes in hemodialysis.