Rare complication of internal jugular vein catheter ectopically placed into the dural sinus: a case report

Central venous catheterization is a procedure involving the percutaneous insertion of a catheter into a central vein, such as the internal jugular, subclavian, or femoral vein. It is frequently used for monitoring central venous pressure (CVP), assessing central venous oxygen saturation (ScvO₂), performing blood purification, providing nutritional support, and administering specialized medications. Among available sites, the internal jugular vein is commonly preferred. Catheter malposition is a recognized complication. Malpositioned catheters typically occur in larger veins, including the internal jugular, axillary, subclavian, and innominate veins. Rarely, ectopic catheter placements occur within smaller vessels associated with the venous trunk, venous sinuses, lymphatic vessels, or, exceptionally, within the arterial system. This article reports a rare case of an internal jugular vein catheter malpositioned intracranially, resulting in infiltration of intravenous nutrient fluid into the cerebrospinal fluid (CSF). The report aims to provide clinical guidance and raise awareness among medical personnel regarding this uncommon complication.

A 6-month-old boy was admitted to the pediatric surgery department for colostomy reversal. Before the operation, internal jugular vein catheterization was successfully performed under ultrasound guidance. However, on the second day after catheter placement, no blood return was obtained from the central venous catheter (CVC). Cervical vascular ultrasound initially suggested normal catheter positioning within the internal jugular vein. On the fourth day after catheterization, the patient developed poor oxygen saturation and seizures. Comprehensive evaluations, including CSF analysis, cervical vascular ultrasound, and radiographs of the skull and chest, strongly suggested that the CVC had inadvertently entered the intracranial dural sinus, causing intravenous nutrient fluid infiltration into the CSF. The patient was managed aggressively with endotracheal intubation, mechanical ventilation, antibiotic therapy, and measures to reduce intracranial pressure. Following treatment, he recovered fully and was discharged from the hospital.

Precise technique and accurate catheter positioning are essential for successful internal jugular vein catheterization. Although ultrasound guidance improves catheterization success rates, it has significant limitations in preventing distal catheter-tip malposition. Therefore, imaging examinations remain critical to confirm catheter placement and trajectory, helping to prevent potential complications.