Dynamics of a Distorted Waveform and Elevated Central Venous Pressure (CVP) Resulting From Coiling of a Central...

Central venous cannulation (CVC) is a routine procedure in critical care and surgical settings. Despite ultrasound guidance, complications like catheter coiling can occur. We report a case of CVC catheter coiling that led to waveform distortion and required corrective measures. A 23-year-old female patient underwent an emergency laparotomy for perforation peritonitis with underlying pulmonary tuberculosis. During the procedure, a triple-lumen CVC was placed in the left internal jugular vein (IJV) after an unsuccessful right IJV cannulation attempt. Upon placement, the CVP was significantly elevated at 31.2 mmHg with a distorted waveform showing exaggerated 'v wave' and diminished 'x descent'. A point-of-care echocardiogram excluded right heart abnormalities. Postoperatively, a chest X-ray revealed coiling of the CVC in the superior vena cava (SVC), forming a fishhook pattern. The catheter was partially withdrawn by 2 cm, resulting in a reduction in CVP to 12 mmHg and normalization of the waveform. The catheter was subsequently removed and replaced without complications. Catheter coiling is an uncommon but significant complication of CVC, even when performed under ultrasound guidance. It can lead to inaccurate CVP readings and waveform distortion, which may affect clinical decisions. Early recognition of abnormal waveforms and partial withdrawal of the catheter can correct the coiling and restore accurate hemodynamic monitoring. This case underscores the importance of waveform analysis as a diagnostic tool for detecting catheter malposition and mechanical complications.