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A haemodialysis catheter misplaced due to central venous stenosis: A case report
1Science and Education Department, Baoding No. 1, Central Hospital, Baoding, China.
Insights
A haemodialysis catheter (HDC) was misplaced into the left internal jugular vein (IJV) due to central venous stenosis (CVS). This case highlights CVS as a cause of HDC misplacement, requiring clinical attention.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Chronic kidney disease (CKD) is a growing global health concern, often progressing to end-stage renal disease (ESRD) requiring renal replacement therapy.
- Vascular access is crucial for haemodialysis (HD) in ESRD patients.
- Haemodialysis catheters (HDCs) inserted into central veins, typically the right internal jugular vein (IJV), are common for emergency vascular access.
Observation:
- A unique case of haemodialysis catheter (HDC) misplacement is presented.
- The HDC tip was inadvertently positioned in the left internal jugular vein (IJV).
- This malposition occurred in a patient with multiple central venous stenoses (CVS).
Findings:
- Central venous stenosis (CVS) can lead to unexpected haemodialysis catheter (HDC) malpositions.
- The anatomical variations caused by CVS can direct the catheter tip into abnormal venous pathways.
- This case underscores the importance of recognizing CVS as a potential cause of HDC misplacement.
Implications:
- Healthcare providers must be vigilant for central venous stenosis (CVS) in patients requiring central venous catheterization.
- Awareness of CVS can prevent complications associated with haemodialysis catheter (HDC) misplacement.
- Pre-procedural imaging or careful anatomical assessment may be warranted in patients with suspected or known CVS.
Abstract:
Chronic kidney disease has become a significant global health issue, with some individuals progressing to endstage renal disease (ESRD) and requiring renal replacement therapy. For ESRD patients undergoing haemodialysis, the first step is to establish vascular access. In emergency situations, inserting a haemodialysis catheter (HDC) into the central vein is often the most appropriate approach; the right internal jugular vein (IJV) is considered the optimal site for catheterisation. However, catheter placement in the right IJV can sometimes lead to inadvertent entry into an abnormal position. Herein, we present a unique case in which the tip of the HDC was noted to have misplaced into the left IJV due to the patient's multiple central venous stenosis (CVS). This case highlights the clinical manifestation of HDC misplacement, with CVS being the underlying cause. Therefore, healthcare providers should pay adequate attention to CVS.
