Malpositioning of internal jugular hemodialysis catheter in great artery is rare but a serious complication. Misplacement of a hemodialysis catheter from internal jugular vein in to arch of aorta is presented.
A 28-year-old male patient diagnosed with chronic kidney disease, underwent cannulation using landmark guidance in preparation for dialysis. Chest X-ray revealed malpositioning of the catheter tip piercing the arch of aorta.
During exploration under general anesthesia surgical approach was through neck, to dissect down to the catheter entry into the thorax. The catheter was removed uneventfully.
Although rare, vascular complications following hemodialysis catheter insertion can lead to considerable morbidity and mortality. If any suspicion of arterial injury arises then it is recommended to leave the catheter in situ and seek prompt vascular surgery consultation
The level of experience of the clinician can also reduce the risk of inadvertent arterial placement of central venous catheter. Use of real time ultrasonography may be helpful.