Acute hemodialysis catheter follows the path of least resistance

Area of Science:

• Nephrology
• Vascular Access
• Interventional Radiology

Background:

• Large bore double-lumen catheters are frequently placed for hemodialysis (HD).
• Catheter malposition is a common complication, necessitating prompt diagnosis and management.
• Accurate placement is crucial for effective hemodialysis and to prevent complications.

Observation:

• A hemodialysis patient with a history of hemophilia and contrast allergy required urgent catheter placement.
• A catheter was placed in the left internal jugular vein, but initial function was inadequate.
• Imaging revealed an unusual malpositioning of the catheter tip.

Findings:

• The catheter was malpositioned in the left superior intercostal vein (LISV), a rare occurrence.
• This malpositioning mimicked intrathoracic extravascular catheter lodgment.
• Successful removal of the malpositioned catheter was achieved without complications.

Implications:

• This case underscores the importance of recognizing rare vascular access complications in hemodialysis.
• Prompt identification and management of catheter malposition are essential for patient safety.
• Understanding uncommon malpositions aids in differentiating them from other serious conditions.