Budd-Chiari syndrome: An unusual complication of an internal jugular tunneled dialysis catheter.

Budd-Chiari syndrome due to the tip of an internal jugular tunneled dialysis catheter malposition in inferior vena cava or hepatic vein is a rare complication. We aimed to present our experience and compare it with the previous reports to highlight the clinical features and the optimal management. A 57-year-old female with history of ANCAp vasculitis, treated by hemodialysis in the last 2 years on a right internal jugular vein tunneled catheter was admitted for pain in the right upper quadrant. A subacute Budd-Chiari syndrome due to catheter malposition was diagnosed. The catheter was removed, and a new tunneled hemodialysis line was inserted in the right internal jugular vein with the tip at the junction of right atrium with superior vena cava. Anticoagulation with apixaban 2.5 mg twice daily was started after catheter replacement and the patient was discharged. At 1 month follow-up the patient had no symptoms, and the ultrasound revealed the absence of the thrombus in the inferior vena cava. Imagining monitoring for malposition after insertion or in a clinical context suggestive for Budd-Chiari syndrome is essential for early diagnosis and treatment. In our case, anticoagulation with apixaban and prompt catheter replacement resulted in Budd-Chiari syndrome resolution.

Inadvertent Vertebral Vein Cannulation: Anatomical Considerations and Practical Aspects.

A routine vascular procedure, the central venous catheterization requires recognition of malposition to avoid its serious sequelae. This case report discusses the complications encountered following presumed right internal jugular vein cannulation in a trauma patient. Cervical spine imaging done as part of a trauma protocol revealed a catheter in the right vertebral vein. Inadvertently mispositioned catheter emphasizes the significance of ultrasound-guided central vein catheterization even if the cannulation is done using standard anatomical landmarks. How to cite this article: Vadi S. Inadvertent Vertebral Vein Cannulation: Anatomical Considerations and Practical Aspects. Indian J Crit Care Med 2022;26(8):956-957.

Coiling of central venous catheter in the left subclavian vein, a rare complication.

Invasive monitoring is the need of the hour in today's scenario in intensive care units and perioperatively in hemodynamically unstable patients. Despite careful placement using proper landmarks and USG guided methods central venous canuulation (CVC) is associated sometimes with unforeseen complications. We report a rare complication of coiling of CVC in the left subclavian vein.