Central Venous Pressure Catheter Malposition from Right Internal Jugular Vein into the contralateral innominate vein: A Rare complication

CVCs are inserted for many different indications in cardiac surgery and ICU. These include administering drugs (anaesthetic and vasoactive agents, antibiotics, chemotherapy), monitoring central venous pressure (CVP)or hemodynamic monitoring, measurement of central venous oxygen saturation (SCVO2), renal replacement therapy, total parenteral nutrition, poor peripheral venous access, cardiac catheterization, and transvenous cardiac pacing. Despite the level of skill of the operator and the use of ultrasound guidance, CVC placement can result in CVC malposition. Easy and uncomplicated catheterisation, free aspiration of blood and monitoring of catheterisation do not guarantee correct placement of the IJV catheter. Though, placement of a catheter through the RIJV is associated with the lowest incidence of malposition. Ultrasound, ECG guidance, real-time X-ray imaging, surgical confirmation either by palpation in SVC or visualized in the RA, and saline injection test are definite confirmation and dramatically increase the successful placement of needles, guidewires, and catheters, but significant numbers of catheter misplacements can still occur, particularly if operators are not fully proficient in such techniques. A case of RIJV inserted CVP catheter malposition has been reported in 57 years old, 61 kg and 155cm height with short and thick neck patient presented with triple vessel CAD posted for OP-CABG surgery. Postoperative Chest X-Ray revealed a right sided CVP line catheter malposition in the contralateral innominate vein. Even though, the malposition of the CVP catheter inserted via RIJV is less frequently reported.