Echocardiography-Guided Repositioning of a Hemodialysis Catheter in a Patient With Persistent Left Superior Vena Cava: A Case Report

Persistent left superior vena cava (PLSVC) is an uncommon thoracic venous anomaly that is often identified incidentally during central venous access or thoracic imaging. We describe a case in which transthoracic echocardiography (TTE) was used to safely and effectively reposition a hemodialysis catheter within a PLSVC to enable continuous hemodiafiltration (CHDF). A 71-year-old man developed septic shock complicated by acute kidney injury requiring CHDF. Because vascular access options were limited, a dialysis catheter was inserted via the left internal jugular vein. Imaging revealed that the catheter was located within a PLSVC, and TTE demonstrated that the catheter tip was positioned near the coronary sinus, raising concern for potential cardiac perforation. Under real-time TTE guidance at the bedside, the catheter was withdrawn several centimeters to a safer position. CHDF was subsequently performed for nine days without complications, maintaining a stable blood flow rate. TTE is a valuable bedside tool for confirming and adjusting catheter position in a PLSVC, particularly in critically ill patients who are unsuitable for fluoroscopic imaging.