Straight to the back: Femoral triple lumen catheter misplaced in a lumbar vein
George Horani1, Ahmad Qatanani1, Mubarak Yusuf1
1Department of Pulmonary and Critical Care Medicine, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ 07503, USA.
Insights
Central venous catheter placement is generally safe but can lead to complications like misplacement. This case highlights a rare instance of lumbar vein misplacement, emphasizing the need for vigilance during procedures.
Area of Science:
- Vascular Access Procedures
- Medical Device Complications
- Radiological Imaging
Background:
- Central venous catheters (CVCs) are critical for administering medications, nutrition, and therapies.
- CVC insertion is common but carries risks, including infection, bleeding, and malposition.
- Ultrasound guidance improves safety, yet complications persist.
Observation:
- A case report details a triple lumen catheter misplacement during a left groin approach.
- The catheter was inadvertently inserted into a small lumbar vein side-branch.
- This unusual malposition was identified via computed tomography (CT) scan of the abdomen and pelvis.
Findings:
- The study documents a rare complication of central venous catheterization: extravascular placement into a lumbar vein.
- Computed tomography imaging was crucial for diagnosing the catheter malposition.
- Successful repositioning of the catheter was achieved after identification.
Implications:
- This case underscores the importance of anatomical awareness and imaging in central venous catheterization.
- Recognizing rare malpositions is vital for patient safety and effective treatment.
- Further research into preventing and managing such complications may be warranted.
Abstract:
Central venous catheters are devices inserted into large central veins, usually internal jugular, femoral, or subclavian and serve multiple purposes including administration of vasoactive medications, dialysis, plasmapheresis, total parenteral nutrition, among others. It is considered a relatively safe procedure when performed by experienced clinicians, especially under ultrasound guidance. However, complications are not uncommon and include arterial puncture, injury to nearby structures such as lung puncture leading to pneumothorax, bleeding, infection, and line misplacement. We present a case of a triple lumen catheter which was misplaced in a small lumbar vein side-branch while attempting a left groin approach. This finding was discovered on CT scan of the abdomen and pelvis, after which the catheter was repositioned with proper placement.
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