Catheter-associated vessel perforation presenting as an occluded lumen: lessons learned and preventive strategy

A central venous catheter (CVC) was placed in the left internal jugular vein of a woman in her late 20s, who was admitted to our intensive care unit during the management of her abdominal wall sepsis. Two days later, the patient had pain at the insertion site. Check aspiration revealed the presence of aspirate from all the lumens except the distal lumen. It was assumed that the distal lumen must be abutting the vessel wall and the patient was reassured. However, it was later diagnosed that the distal tip of the CVC had perforated the left brachiocephalic vein and had migrated into the superior mediastinum. Assumption of an intraluminal location of CVC or abutment of the vessel wall must be disregarded.CVC occlusion can be due to various causes including malposition or migration, mechanical obstruction, fibroblastic sleeve and CVC-related thrombosis. A systematic evaluation of all the causes of CVC occlusion will lead to an early diagnosis. The placement of the CVC tip in the safe zone must be emphasised.