Misplacement of a right internal jugular vein haemodialysis catheter into the mediastinum

MKH Tong, YP Siu, YY Ng, TH Kwan, TC Au
Division of Nephrology, Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong

A 69-year-old woman with end-stage renal failure discontinued continuous ambulatory peritoneal dialysis and commenced temporary haemodialysis because of resistant peritonitis. Right internal jugular vein haemodialysis catheter placement was performed. The cuffed, tunnelled haemodialysis catheter was inserted using the modified Seldinger technique. When haemodialysis was initiated the following day, blood could not be aspirated from the catheter and the patient complained of central chest pain during the aspiration. Subsequent venography and computed tomography scan of the thorax showed that the catheter was placed extraluminally into the posterior mediastinum. The importance of a chest radiograph after placement of a central venous catheter is highlighted by this case report. Subtle deviations in catheter position from normal should alert the physician to the possibility of catheter misplacement and lead to further investigation.

Hong Kong Med J 2004;10:135-8

Key words: Catheterization; Kidney failure, chronic; Mediastinum; Renal dialysis