|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 4 | Page : 219-220
Spontaneous retrograde coiling of central venous catheter into the ipsilateral internal jugular vein: Can it happen?
Ankur Khandelwal, Surya Kumar Dube, Gyaninder P Singh
Department of Neuro-Anaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||15-Apr-2020|
|Date of Acceptance||29-Apr-2020|
|Date of Web Publication||13-Jul-2020|
Dr. Surya Kumar Dube
Associate Professor, Department of Neuro-Anaesthesiology and Critical Care, 7th Floor, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Khandelwal A, Dube SK, Singh GP. Spontaneous retrograde coiling of central venous catheter into the ipsilateral internal jugular vein: Can it happen?. J Pediatr Crit Care 2020;7:219-20
|How to cite this URL:|
Khandelwal A, Dube SK, Singh GP. Spontaneous retrograde coiling of central venous catheter into the ipsilateral internal jugular vein: Can it happen?. J Pediatr Crit Care [serial online] 2020 [cited 2020 Aug 9];7:219-20. Available from: http://www.jpcc.org.in/text.asp?2020/7/4/219/289531
Central venous catheters (CVC) malposition is not an uncommon and postprocedure chest X-ray gives information about the catheter location. However, daily chest X-ray is not advisable to follow-up the position of CVC. With this practice, we may miss the CVC malposition occurring after a correct placement. We report one such case of spontaneous malposition of CVC on 5th day postinsertion.
A 5.5 Fr triple lumen CVC (Certifix Trio® B. Braun, Melsungen AG) was inserted under direct ultrasound visualization in second attempt into the right internal jugular vein (IJV) of a 9-years-old female child posted for the right fronto-parieto-temporal craniectomy. There was no thoracoabdominal/neck injury in the child. The CVC was found to be in correct position postoperatively [Figure 1]a. No further chest X-rays were done since the patient apparently did not have any lung pathology. On 5th day, there were erroneous readings of central venous pressure (CVP) which did not correlate with the patient's clinical state. In addition, free flow of blood could not be obtained from any of the CVC ports. A chest X-ray was done which showed retrogradely coiled CVC into the ipsilateral IJV [Figure 1]b. The catheter was subsequently removed, and a new triple lumen CVC was inserted into the left IJV.
|Figure 1: (a) Chest X-ray shows central venous catheters in the right internal jugular vein (1st day of intensive care unit). (b) Retrograde coiled central venous catheters (5th day of intensive care unit)|
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A mal-positioned CVC can lead to erratic readings of CVP, formation of coagulum, catheter erosion, and thrombophlebitis. Maneuver described to prevent misplacement of CVC into ipsilateral IJV during subclavian vein cannulation may not prevent coiling of the CVC inside ipsilateral IJV. Moreover, CVC that are inserted successfully can coil subsequently during treatment. The most important factor leading to retrograde coiling is the reversal of venous blood flow secondary to IJV valve incompetence. Incompetence of IJV valve can occur in patients with a history of previous cannulation or it can be due to trauma to the IJV valve by multiple attempts at the time of cannulation. Factors such as chronic obstructive pulmonary disease, pulmonary hypertension, and high intrathoracic or intra-abdominal pressures increase chances of the IJV valve malfunction and hence allow retrograde flow into the IJV there by leading to coiling of the CVC. The most probable explanation for the retrograde coiling of CVC in our case is IJV valve malfunction (caused by IJV valve injury at the time of cannulation) leading to retrograde flow of blood into IJV due to transient rise of intrathoracic pressure anytime during to mechanical ventilation.
The presence of valve in IJV is quite common and it is mostly located in the distal portion of the IJV, just proximal to the jugular bulb in the retroclavicular space. This position might make the ultrasound assessment of the valve difficult during routine cannulation, leading to its injury. With this report we want to emphasize that spontaneous retrograde coiling of CVC can happen days after the IJV cannulation due to IJV valve malfunction and rise in intrathoracic or intra-abdominal pressure. The possible way to prevent it is to avoid IJV valve injury during cannulation and to prevent the factors aggravating the retrograde blood flow into IJV. A high index of suspicion is required to detect retrograde coiling of CVC into IJV especially in cases where multiple attempts were made during cannulation and daily/frequent chest X-ray is not done. In cases of retrograde coiling of CVC into IJV, we suggest removal of CVC and insertion of CVC into another site.
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