On the way to the azygos vein: a road of return rather than ruined.

Azygos vein Central venous catheter Malposition

Journal

Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113

Informations de publication

Date de publication:
20 Apr 2024
Historique:
received: 26 11 2023
accepted: 29 03 2024
medline: 21 4 2024
pubmed: 21 4 2024
entrez: 20 4 2024
Statut: epublish

Résumé

The malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right subclavian vein into the azygos vein is extremely rare. Here, we report a patient with CVC malposition into the azygos vein via the right subclavian vein. We conduct a comprehensive review of the anatomical structure of the azygos vein and the manifestations associated with azygos vein malposition. Additionally, we explore the resolution of repositioning the catheter into the superior vena cava by carefully withdrawing a specific length of the catheter. A 79-year-old female presented to our department with symptoms of complete intestinal obstruction. A double-lumen CVC was inserted via the right subclavian vein to facilitate total parenteral nutrition. Due to the slow onset of sedative medications during surgery, the anesthetist erroneously believed that the CVC had penetrated the superior vena cava, leading to the premature removal of the CVC. Postoperative contrast-enhanced computed tomography of the chest confirmed that the central venous catheter had not penetrated the superior vena cava but malpositioned into the azygos vein. The patient was discharged 15 days after surgery without any complications. CVC malposition into the azygos vein is extremely rare. Clinical practitioners should be vigilant regarding this form of catheter misplacement. Ensuring the accurate positioning of the CVC before each infusion is crucial. Utilizing chest X-rays in both frontal and lateral views, as well as chest computed tomography, can aid in confirming the presence of catheter misplacement.

Sections du résumé

BACKGROUND BACKGROUND
The malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right subclavian vein into the azygos vein is extremely rare. Here, we report a patient with CVC malposition into the azygos vein via the right subclavian vein. We conduct a comprehensive review of the anatomical structure of the azygos vein and the manifestations associated with azygos vein malposition. Additionally, we explore the resolution of repositioning the catheter into the superior vena cava by carefully withdrawing a specific length of the catheter.
CASE PRESENTATION METHODS
A 79-year-old female presented to our department with symptoms of complete intestinal obstruction. A double-lumen CVC was inserted via the right subclavian vein to facilitate total parenteral nutrition. Due to the slow onset of sedative medications during surgery, the anesthetist erroneously believed that the CVC had penetrated the superior vena cava, leading to the premature removal of the CVC. Postoperative contrast-enhanced computed tomography of the chest confirmed that the central venous catheter had not penetrated the superior vena cava but malpositioned into the azygos vein. The patient was discharged 15 days after surgery without any complications.
CONCLUSIONS CONCLUSIONS
CVC malposition into the azygos vein is extremely rare. Clinical practitioners should be vigilant regarding this form of catheter misplacement. Ensuring the accurate positioning of the CVC before each infusion is crucial. Utilizing chest X-rays in both frontal and lateral views, as well as chest computed tomography, can aid in confirming the presence of catheter misplacement.

Identifiants

DOI: 10.1186/s13019-024-02708-9 PMID: 38643163
pubmed: 38643163
doi: 10.1186/s13019-024-02708-9
pii: 10.1186/s13019-024-02708-9
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

259

Subventions

Organisme : Natural Science Foundation of China
ID : 82072126
Organisme : Natural Science Foundation of China
ID : 82072126
Organisme : Natural Science Foundation of China
ID : 82072126
Organisme : Natural Science Foundation of China
ID : 82072126
Organisme : Zhejiang Provincial Key Research and Development Program of China
ID : 2021C03073, 2023C03085
Organisme : Zhejiang Provincial Key Research and Development Program of China
ID : 2021C03073, 2023C03085
Organisme : Zhejiang Provincial Key Research and Development Program of China
ID : 2021C03073, 2023C03085
Organisme : Zhejiang Provincial Key Research and Development Program of China
ID : 2021C03073, 2023C03085
Organisme : Natural Key Research and Development Program of China
ID : 2022YFC2401900, 2022YFC2403604
Organisme : Natural Key Research and Development Program of China
ID : 2022YFC2401900, 2022YFC2403604
Organisme : Natural Key Research and Development Program of China
ID : 2022YFC2401900, 2022YFC2403604
Organisme : Natural Key Research and Development Program of China
ID : 2022YFC2401900, 2022YFC2403604
Organisme : Key Program Co-sponsored by Zhejiang Province and National Health Commission of China
ID : WKJ-ZJ-2207
Organisme : Key Program Co-sponsored by Zhejiang Province and National Health Commission of China
ID : WKJ-ZJ-2207
Organisme : Key Program Co-sponsored by Zhejiang Province and National Health Commission of China
ID : WKJ-ZJ-2207
Organisme : Key Program Co-sponsored by Zhejiang Province and National Health Commission of China
ID : WKJ-ZJ-2207

Informations de copyright

© 2024. The Author(s).

Références

Bell T, O’Grady NP. Prevention of Central Line-Associated Bloodstream infections. Infect Dis Clin North Am. 2017;31(3):551–9.
doi: 10.1016/j.idc.2017.05.007 pubmed: 28687213 pmcid: 5666696
Baskin JL, Pui CH, Reiss U, et al. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet. 2009;374(9684):159–69.
doi: 10.1016/S0140-6736(09)60220-8 pubmed: 19595350 pmcid: 2814365
Roldan CJ, Paniagua L. Central venous catheter intravascular malpositioning: causes, Prevention, diagnosis, and correction. West J Emerg Med. 2015;16(5):658–64.
doi: 10.5811/westjem.2015.7.26248 pubmed: 26587087 pmcid: 4644031
NATHAN H. Anatomical observations on the course of the azygos vein (vena azygos major). Thorax. 1960;15(3):229–32.
doi: 10.1136/thx.15.3.229 pubmed: 13727912 pmcid: 1018568
Haygood TM, Malhotra K, Ng C, Chasen B, McEnery KW, Chasen M. Migration of central lines from the superior vena cava to the azygous vein. Clin Radiol. 2012;67(1):49–54.
doi: 10.1016/j.crad.2011.05.011 pubmed: 22070939
Wang Y, Zhao L. Diagnosis and management of secondary malposition of PICC into the azygos vein. J Vasc Access. 2022;23(3):450–4.
doi: 10.1177/1129729821999484 pubmed: 33719694
Ablordeppey EA, Huang W, Holley I, Willman M, Griffey R, Theodoro DL. Clinical practices in central venous catheter mechanical adverse events. J Intensive Care Med. 2022;37(9):1215–22.
doi: 10.1177/08850666221076798 pubmed: 35723623
Pua U. Imaging teaching case. Radiographic features of malpositioning of a hemodialysis catheter in the azygos vein. Am J Kidney Dis. 2010;55(2):395–8.
doi: 10.1053/j.ajkd.2009.06.041 pubmed: 19781832
Granata A, Figuera M, Castellino S, Logias F, Basile A. Azygos arch cannulation by central venous catheters for hemodialysis. J Vasc Access. 2006;7(1):43–5.
doi: 10.1177/112972980600700109 pubmed: 16596529
Wang M, Xu L, Feng Y, Gong S. Misplacement of a central venous catheter into azygos vein via the right internal jugular vein. J Vasc Access. 2021;22(6):1004–7.
doi: 10.1177/1129729820950996 pubmed: 32787623

Auteurs

Yiping Feng (Y)

Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China.

Yeqing Liu (Y)

Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Heath, Hangzhou, China.

Shanxiang Xu (S)

Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China.

Huiming Zhong (H)

Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China.

Shouyin Jiang (S)

Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China. jansoean@zju.edu.cn.
Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China. jansoean@zju.edu.cn.

Classifications MeSH