Coiling of central venous catheter in the left subclavian vein, a rare complication
A 73 year old female, a post sternotomy for retrosternal goitre resection was admitted with sternal dehiscence (having sero-sanguineous discharge from chest wire site) and respiratory distress on the third post operative day. On the day of surgery, a right subclavian CVP (because of neck surgery and possibility of tracheostomy) was placed and tracheostomy performed because of surgical concern. The patient received ventilator support, hemodynamic monitoring, empiric broad spectrum antibiotics, colostomy bag at wound site care for two hourly suction and general ICU care. On the sixth day of ICU admission pus at CVC insertion site was noticed, and was decided to change the catheter as per protocol. To change the site, left subclavian vein was cannulated with a 7.5F triple lumen CVP catheter (Edward) using standard Seldinger technique with ultrasound guidance (USG) (Sonosite, USA) under all aseptic precautions. We used the lateral approach with the needle inserted longitudinal to the transducer. The guide wire was confirmed well in position in the vein. The guide wire movement was free at insertion and during its removal after the placement of the CVP catheter. All channels of the CVC were aspirated for blood and fixed at 12 cm. On attaching the transducer to the monitor the CVP waveform appeared dampened, and despite all described standards measures it could not be improved []. A chest radiograph performed after insertion to confirm the position of catheter revealed that it was coiled in a C- shaped pattern either in the same vein or possibly in one of the large venous tributaries of the left subclavian vein []. The left subclavian CVC was removed and a new left internal jugular (IJV) catheter was placed by Seldinger technique using USG guidance. The guide wire was confirmed well in position in the vein- it could be traced much beyond the subclavian vein. A repeat chest radiograph confirmed the correct placement with normal CVP tracing.