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What can a thrombus in the superior vena cava (SVC) do to a jugular haemodialysis catheter?

An 80-year-old lady with diabetes mellitus, hypertension and ischaemic heart disease, chronic kidney disease with a baseline serum creatinine of 300 μmol/L was admitted for acute pulmonary edema secondary to acute coronary syndrome (ACS) and required noninvasive ventilatory (NIV) support. She developed acute-on-chronic kidney failure with serum creatinine rising to 500 μmol/L with oliguria and further desaturation despite noninvasive ventilatory (NIV) support and echocardiography showed global hypokinesia with ejection fraction down to 30%. She was transferred to intensive care 2 days later and underwent ultrasound-guided temporary haemodialysis catheter insertion into the right internal jugular vein (IJV) (Figure 1A). She had two CRRT sessions with net ultrafiltration of 6 L and was weaned off NIV support. She returned to the general medical ward after 3 days of ICU stay and received maintenance haemodialysis twice a week. On Day 12, change of the haemodialysis catheter over a guidewire was attempted, but there was resistance as the guidewire was advanced to 20–22 cm from the venous entry port, and the catheter was removed. Two days later, ultrasound-guidance insertion of another haemodialysis catheter into the right IJV was attempted, but was again met with resistance after advancing 22 cm down the insertion site, and a 16 cm-long catheter was finally inserted using the Seldinger