TREAD CAREFULLY ON THIS SIDE OF THE ROAD: LEFT-SIDED CENTRAL VENOUS CATHETER MIGRATION TO THE AZYGOUS VEIN

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Central venous catheters (CVC) are commonly used in intensive care units for patients who require frequent or long-term access. The position of the catheter is confirmed with chest radiography. desired location tip usually superior vena cava (SVC), preferably near cavoatrial junction. Different malpositions evident on anteroposterior (AP) x-ray. Still, it can be challenging to identify azygous malposition frontal imaging alone, which most utilized view an setting. CASE PRESENTATION: A 64-year-old male was admitted Intensive unit (ICU) management septic shock requiring vasopressor therapy. decision made place a left intrajugular vein (IJV) catheter. An AP semi-erect obtained confirm line placement, and read as limited IJV expected SVC/right atrial junction (fig 1). Twenty four hours after CVC repeat CXR due difficulty blood return 2). He further underwent CT chest/abdomen, showed IJ central 3). retracted later removed. Fortunately, he did not suffer any complications from procedure subsequently discharged hospital few days. DISCUSSION: (CVCs), once placed, static. CVCs move changes patient so that may shift 2–3 cm depending patient's position. When migration occurs, theoretically end up vessel reach. In case into azygos vein, initial left-sided placement must considered risk. Other risk factors include small French size, silicone catheter, like coughing, movement, etc. [1,2]. Care taken when placing negotiating two 90 degree turns because anatomy jugular system side. CONCLUSIONS: It essential recognize elevated lines placed vein. REFERENCE #1: Haygood TM, Malhotra K, Ng C, Chasen B, McEnery KW, M. Migration Clin Radiol. 2012 Jan;67(1):49-54. doi: 10.1016/j.crad.2011.05.011. Epub 2011 Nov 8. PMID: 22070939. #2: Hignell ER, Phelps J. Recurrent brittle asthma. J Vasc Access. 2020 Jul;21(4):533-535. 10.1177/1129729819874993. 2019 Sep 16. 31526101. DISCLOSURES: No relevant relationships by Navdeep Brar, source=Web Response Hafiz Muhammad Siddique Qurashi, Tabinda Saleem, Michaela Sangillo, Kolsoum Yari,