جابجایی کاتتر وریدی مرکزی کمیاب در یک دختر 10 ساله A Rare Central Venous Catheter Malposition in a 10-Year-Old Girl

1. Introduction Central venous catheterization plays an important role in modern medical practice. It is estimated that approximately 8% of hospitalized patients require central venous access during the course of their hospital stay, and it has been estimated that more than five million CVCs are inserted in patients in the United States each year [1, 2]. Indications for CVC placement are diverse. Some of the more common indications include invasive hemodynamic monitoring, parenteral nutrition support, dialysis, chemotherapy, fluid resuscitation, drug administration, and renal replacement therapy. Although CV catheterization is a simple and relatively safe procedure, many complications have been reported during or after the procedure. Malposition is one of the complications observed. In this report, we describe a rare case of malposition in a 10-year-old girl. 2. Case Presentation The patient was a 10-year-old girl, recently diagnosed with leukemia and hospitalized for treatment. She required central venous (CV) line placement for chemotherapy. Other than her diagnosed leukemia, she had no other significant medical history. After the procedure was explained thoroughly to the patient and her parents, a consent form was completed by her parents, and she was transferred to the CV line room. The patient was very alert and cooperative. Based on the local protocols, all patients requiring CV line placement are transferred to a room dedicated for CV line placement (the intravenous access room), which is located in the operating room. Standard monitoring including an electrocardiogram (ECG), noninvasive blood pressure, and pulse-oximetry were initiated. A 20-gauge cannula was inserted into the vein on the dorsum of the patient’s left hand. The right internal jugular vein was selected for CV cannulation. Propofol was used for sedation, and after adequate sedation, a single-lumen 14-gauge catheter was inserted in the right internal jugular vein using ultrasound sonography under sterile conditions by an experienced anesthesiologist. No problem was encountered during the procedure, and after blood was aspirated, the catheter was fixed at 13 cm. Normal saline infusion was initiated through the CV. Central venous waveforms were not used for catheter position confirmation. A chest radiograph was immediately arranged to confirm the catheter position.