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Accidental Central Venous Catheter Placement in the Internal Thoracic Vein: A Case Report
Patrick Goodin1, Nikita Jain2, Hafiz Muhammad Jeelani3
1Anesthesiology, Indiana University School of Medicine, Indianapolis, USA.
Insights
Internal thoracic vein (ITV) cannulation during central venous catheter placement is rare. This case study details management strategies for this complication, suggesting potential therapeutic uses.
Area of Science:
- Critical Care Medicine
- Vascular Access Procedures
- Anatomical Variations
Background:
- Central venous catheter (CVC) placement is a critical procedure in intensive care.
- Malpositioning of CVCs, particularly from internal jugular vein (IJV) cannulation, is a recognized complication.
- Cannulation of the internal thoracic vein (ITV) is an exceptionally rare event with limited documented cases and no established management guidelines.
Observation:
- This case report describes a rare instance of internal thoracic vein cannulation during central venous catheter insertion.
- The report discusses associated risk factors, identifies warning signs of malpositioning, and outlines management strategies.
- Previous research utilized fluoroscopy and agitated saline tests to confirm right atrial access from an ITV catheter.
Findings:
- The study documents a rare case of internal thoracic vein cannulation, highlighting its infrequency.
- It provides a detailed account of risk factors, warning signs, and management protocols for ITV catheter malposition.
- Confirmation of right atrial access via fluoroscopy and saline tests supports the potential utility of ITV catheters.
Implications:
- The findings underscore the need for heightened awareness and preparedness for rare CVC malpositions like ITV cannulation.
- Management strategies discussed can enhance patient safety and optimize outcomes in critical care settings.
- The theoretical potential for using ITV-located catheters for medication delivery, especially in emergencies, warrants further investigation.
Abstract:
Central venous catheter (CVC) placement is an essential component of critical care medicine. CVC malposition is a known complication of internal jugular vein (IJV) cannulation. However, catheterization of the internal thoracic vein (ITV) is much rarer. Only a handful of case reports have been documented, and guidelines for management are therefore lacking. Our case study describes this rarely occurring ITV cannulation along with the discussion of risk factors, warning signs of malpositioning, and subsequent management plans to optimize patient safety. Previous studies have used fluoroscopy and agitated saline flush tests to confirm that agents administered through an ITV-located catheter would reach the right atrium. Considering this, it would follow that a catheter in this site could theoretically be used for medication administration, especially in emergency settings. This hypothesis remains the most novel part of our case study and might prompt further exploration of management strategies in this particular situation.
