Thoracic duct cannulation during left internal jugular vein cannulation: A case report

Area of Science:

• Vascular Access Procedures
• Thoracic Surgery
• Anesthesiology

Background:

• Central venous catheter insertion is a common invasive procedure.
• Potential complications include infection, embolization, pneumothorax, hemothorax, and chylothorax.
• Thoracic duct injury is a rare but serious complication.

Observation:

• A case of suspected thoracic duct cannulation during left internal jugular vein catheterization is reported.
• Clear fluid, suspected lymphatic fluid, was regurgitated from the catheter.
• Chest X-ray showed an appearance consistent with the thoracic duct's path.

Findings:

• The patient underwent central venous catheterization for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
• Blood reflux was noted outside the ultrasound field of view during insertion.
• Clear fluid, not blood, was obtained from the catheter, suggesting lymphatic fluid.

Implications:

• This case highlights the risk of thoracic duct cannulation during central venous catheterization.
• Emphasizes the critical importance of using ultrasound to visualize the needle tip and guide wire path.
• Ensuring accurate placement can prevent rare but severe complications and improve patient safety.