Abstract

Background: Central venous catheter (CVC) malposition is a recognized complication of subclavian venous catheterization, with misdirection into the ipsilateral internal jugular vein (IJV) being one of the more commonly encountered mal-positions. Prompt recognition and correction of such misplacements are crucial to prevent complications such as thromboembolism, vascular injury or impaired catheter function. Objective: To report a case of inadvertent malposition of a subclavian central venous catheter into the ipsilateral internal jugular vein in a critically ill patient and its subsequent successful repositioning. Case Presentation: A 32-year-old female patient presented to the general surgery outpatient department of our hospital with complaints of acute abdominal pain, vomiting and discharge from an abdominal wound. After relevant work-up and optimisation, she underwent an exploratory laparotomy for suspected perforation peritonitis with peritoneal lavage and primary jejunal repair. Postoperatively, she was shifted to the critical care unit and required total parenteral nutrition (TPN). A right subclavian vein catheterization was done for central venous access and the catheter fixed at 12cm mark at skin. Post-insertion chest radiograph revealed mal-positioning of the catheter tip into the right internal jugular vein. The catheter was subsequently withdrawn to 10cm and 8cm at skin, successively, guided by chest radiographs and finally fixed at 8cm at skin which revealed catheter tip at the junction of subclavian vein and internal jugular vein.

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