A convenient technique of rapid detection and correction of misplaced central venous catheter

Abstract

A 71 year old male patient was treated conservatively for subarachnoid haemorrhage with septic shock. The subclavian vein cannulation was done after starting mechanical ventilation and a pressure transducer was attached but the absence of typical waveforms led to doubt of correct placement of the catheter. An internal jugular vein (IJV) occlusion test showed flattened trace and central venous pressure (CVP) rise of 5 mmHg indicating misplacement of the catheter into the IJV, later confirmed by chest radiography. The central venous catheter (CVC) was withdrawn under image intensifier guidance and reinserted after applying pressure over the ipsilateral IJV. The position of the CVC was rechecked by connecting a pressure transducer. This time after IJV occlusion, the CVP trace was good and there was no change in waveforms and CVP reading.

DOI: 10.3329/pulse.v3i1.6553

Pulse Vol.3(1) July 2009 p31-32