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Central venous catheterization via persistent left superior vena cava

R K Josloff1, J S Kukora

  • 1Department of Surgery, Abington Memorial Hospital, Pennsylvania, USA.

The American Surgeon
|September 1, 1995
PubMed
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A subclavian catheter appearing malpositioned was confirmed as correctly placed in a persistent left superior vena cava. This case highlights safe use of central venous catheters in rare anatomical variations.

Area of Science:

  • Cardiology
  • Radiology
  • Pediatric Surgery

Background:

  • Central venous catheter placement is crucial for therapies like total parenteral nutrition.
  • Malposition of subclavian catheters can be suggested by unusual anatomical courses, such as along the left cardiac border.
  • Persistent left superior vena cava (PLSVC) is a rare congenital anomaly where the typical right-sided superior vena cava is absent.

Observation:

  • A subclavian catheter's course along the left lateral border of the heart raised concerns for malposition.
  • Diagnostic workup included blood gas analysis, lateral chest X-ray, and venography.
  • These investigations confirmed the catheter's correct placement within a PLSVC.

Findings:

  • The catheter, despite its unusual course, was successfully utilized for total parenteral nutrition.

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  • No immediate or short-term complications were observed during catheter use.
  • The case demonstrates the feasibility of using central venous access in the presence of PLSVC.

    • Implications:

    • Accurate diagnosis of catheter position is essential, even with apparent malposition.
    • Understanding embryological variations like PLSVC is vital for interventional procedures.
    • This case supports the safe management of patients with PLSVC requiring central venous access.