Introduction

Central venous catheterization is a critical procedure for patients requiring hemodialysis, but complications can arise even with expert care. In this case, a hemodialysis catheter tip was mistakenly placed in the right internal mammary vein—a rare occurrence. This report highlights the challenges of catheter misplacement, the importance of early detection, and best practices for correction.

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Case Presentation

A 57-year-old male with chronic kidney disease (CKD) stage 5 had undergone multiple hemodialysis catheter placements over four years. After experiencing catheter malfunction, a new temporary catheter was inserted into the right internal jugular vein.

Key Findings & Diagnostic Challenges

• Ultrasound guidance was used, and the catheter tip initially appeared to be in the superior vena cava.
• The patient experienced chest pain and resistance during guidewire insertion, raising concerns about misplacement.
• A chest X-ray was inconclusive, but a CT scan with contrast confirmed the catheter tip was in the right internal mammary vein.

Management & Outcome

• The catheter was adjusted to improve blood flow, increasing the dialysis efficiency.
• A fluoroscopically guided tunneled catheter was placed correctly in the superior vena cava for long-term use.
• The patient remained stable with no major complications after catheter repositioning.

Discussion

While catheter misplacement is uncommon, this case underscores the need for a high index of suspicion when patients report discomfort during insertion.

• Ultrasound guidance improves success rates but does not eliminate all risks.
• CT angiography or fluoroscopy should be considered for suspected malposition cases.
• Prompt correction is essential to avoid complications like thrombosis or vessel perforation.

According to the National Kidney Foundation (NKF), early planning for arteriovenous fistula (AVF) creation is recommended to reduce long-term reliance on catheters【1】.

Conclusion

This rare case emphasizes the importance of careful imaging, prompt recognition of catheter malposition, and guided corrections to ensure patient safety.

Read the full study: https://doi.org/10.29328/journal.jcn.1001098

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