A complication of direct right atrial catheterization for total parenteral nutrition

A markedly malnourished man with Crohn's disease and superior vena cava thrombosis required direct right atrial catheterization for total parenteral nutrition. After 3 wk the catheter had migrated to the right pleural space, necessitating removal. An inferior vena cava line via the left saphenous vein was then utilized until the patient's death 10 wk later from pneumonitis. Technical suggestions for avoiding this complication and alternative venous access sites are discussed.