IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 11, Issue 6 (Nov.- Dec. 2013), PP 07-09 www.iosrjournals.org www.iosrjournals.org 7 | Page Malposition of Central Venous Catheter – Three case reports. Dr Prathibha R. Mohan 1 , Dr Harish Hegde 2 , Dr Sampathila Padmanabha 3 , Dr Faisal M. Qureshi 4 , Dr Sheikh Imran 5 1 (Department of Anaesthesiology, Yenepoya Medical College, India) 2 (Professor, Department of Anaesthesiology, Yenepoya Medical College, India) 3 (Head of the Department, Department of Anaesthesiology, Yenepoya Medical College, India) 4 (Department of Anaesthesiology, Yenepoya Medical College, India) 5 (Department of Anaesthesiology, Yenepoya Medical College, India) Abstract: Central Venous Cannulation is a routine procedure done in the Operation Theatre and the Intensive Care Unit. Malpositioning is a very common occurance with the regular anatomical landmark technique. As the central venous catheters are essential in various critical care scenarios, hence any misplacement can hamper its purpose. Here we have three cases where in we saw the migration of the Right Subclavian Vein Catheter into the Ipsilateral Internal Jugular Vein, Contralateral Subclavian Vein and into the Ipsilateral External Jugular Vein radiologically. Hence a thorough knowledge of normal and variant anatomy is required for the proper positioning of Central Venous Catheters. Also radiological techniques like ultrasound guided cannulation may avoid inadverdent arterial puncture but may not be able to avoid malpositioning. Keywords: Central Venous Catheter, Malposition, Right Subclavian Vein. I. Introduction Central Venous Catheterization is a regular procedure done in the Operation Theatre and the Intensive Care Unit. It is a challenging procedure which requires a good knowledge about the normal and variant anatomy and some expertise is required for the correct placement. Any misplacement can hamper its purpose and lead to further complications which may be life threatening also. Some of the complications that may occur with malpositioning can be thrombosis, thrombophlebitis and inaccurate measurement of Central Venous Pressure.[1] Embryological variations such as persistent left – sided superior vena cava[2] are often diagnosed incidentally only after placement of a Central Venous Catheter, which is seen to take an abnormal course on X – ray. Acquired abnormalities such as stenosis or thrombosis of the central veins can be problematic and can present as a failure to pass a guidewire or catheter or complications after many such attempts. II. Case Reports 2.1 Case 1: A 55 yr old male patient operated for carcinoma cheek required parenteral nutrition. The Right Subclavian Vein was cannulated and post cannulation a chest radiograph was taken which reveled migration of the catheter into the Ipsilateral Internal Jugular Vein. Later the catheter was removed and reinserted and the position was confirmed in the Superior Vena Cava radiographically. Fig. 1- This figure shows the migration of the Right Subclavian Vein Catheter into the ipsilateral Internal Jugular Vein. Case 2: A 65 yr old lady with uncontrolled diabetes mellitus came to us with altered sensorium, hyperglycemia and dyselectrolytemia who required electrolyte corrections. A Right subclavian vein cannulation was attempted but revealed its migration into the contralateral Subclavian vein which was then withdrawn and positioned in the superior vena cava.