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Intravascular Misplacement of Central Venous Catheter – Recommendations for Practical Management

SUMMARY. There are various complications of central venous catheter (CVC) insertion, including misplacement. We present case report where CVC was misplaced from right internal jugular vein (IJV) to right subclavia. The patient was 70 years old male with intestinal neoplasma, undergoing the procedure of hemicolectomy and CVC was inserted in the operation ward considering possible blod loss. The CVC was placed using blind technique and without difficulty, trough right IJV. It was completely functional during surgery. Upon admission to Intensive Care Unit, routine chest radiograph was obtained which detected misplacement of the CVC. The position of the CVC was unusual, and clinical signs of misplacement were missing. An attempt to reposition the catheter was made, which was unsuccessful. Chest radiograph showed no signs of pneumothorax so the misplaced catheter was removed and a new one was placed in the same place – right IJV, once again using blind technique. The correct position of the CVC was confirmed by another chest radiograph. We concluded it is important to consider CVC misplacement, even though there are no clinical signs of it. When there is a lack of clinical presentation, imaging is the only indicator of incorrect CVC position. Misplaced CVC should be corrected regardless of its functionality.