Malpositioning of a Central Venous Catheter in the Vertebral Vein Through the Cervical Transverse Foramen: A Case Report

Central venous catheters (CVCs) are commonly used for multiple clinical purposes. The internal jugular vein (IJV) is preferred among the most frequently used insertion sites due to its higher success rates and lower complication risks. Although CVC placement is generally considered a safe procedure, several complications have been reported. Catheter malpositioning, one of the most common procedural complications, can lead to potentially fatal outcomes if not promptly addressed. Although catheter malpositioning is well-documented in various anatomical locations, accidental CVC cannulation of the vertebral vein is rare and has not been previously reported. We present a case of a 65-year-old man diagnosed with Guillain-Barré syndrome who underwent echo-guided CVC insertion into his right neck. The subsequent X-ray and CT scans revealed that the CVC insertion point was dorsolateral to the right sternocleidomastoid muscle. The catheter was passed dorsally to the right IJV and common carotid artery, passing through the C6 transverse foramen. The catheter's position raised concerns for potential complications, such as a vertebral arteriovenous fistula (AVF) or venous thromboembolism. Consequently, the CVC was removed after confirming the absence of AVF, bleeding, or thromboembolisms. This case is clinically significant, highlighting the potential for CVC malposition in the vertebral vein. It underscores the importance of careful monitoring during CVC insertion and removal, with particular attention to the potential for unexpected hemorrhagic events.