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< Vol. 17 Issue 4 | Jul-Aug 2016 | pp. 293 - 372, e65 - e141

Dialysis catheter placement via the left internal jugular vein: risk of brachiocephalic vein perforation

Dialysis catheter placement via the left internal jugular vein: risk of brachiocephalic vein perforation

J Vasc Access 2016; 17(4): e75 - e78

Article Type: CASE REPORT

DOI:10.5301/jva.5000566

Authors

Michiel B. Winkes, Maarten J. Loos, Marc R. Scheltinga, Joep A. Teijink

Abstract

We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion.

An 80-year-old patient underwent an ultrasound-guided hemodialysis (HD) catheter placement via his left internal jugular vein (IJV). One day postoperatively, the patient became hemodynamically unstable immediately after HD initiation. As a vascular event was feared, an emergency CT scan was performed demonstrating a BCV perforation. The patient underwent a sternotomy, the lines were removed and the venous laceration was closed. The patient recovered well.

In spite of ultrasound guidance, fluoroscopy for guidewire and sheath advancement, venous blood aspiration and a normal appearing postoperative x-ray, traumatic central venous catheter placement is still possible. Tenting of the BCV wall during catheter advancement possibly caused the venous perforation. A ‘how-to’ for correct catheter placement via the IJV is provided and potential pitfalls during each procedural step are discussed.

Article History

  • • Accepted on 28/03/2016
  • • Available online on 17/05/2016
  • • Published online on 12/07/2016

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: None of the authors has financial interest related to this study to disclose.

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Authors

  • Winkes, Michiel B. [PubMed] [Google Scholar] 1, * Corresponding Author (m.winkes@mmc.nl)
  • Loos, Maarten J. [PubMed] [Google Scholar] 1
  • Scheltinga, Marc R. [PubMed] [Google Scholar] 1, 2
  • Teijink, Joep A. [PubMed] [Google Scholar] 2, 3

Affiliations

  • Department of Vascular Surgery, Máxima Medical Center, Veldhoven - The Netherlands
  • CARIM Research School, Maastricht University, Maastricht - The Netherlands
  • Cardiovascular Center, Catharina Hospital, Eindhoven - The Netherlands

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