Central line placement in the presence of a ventriculo-atrial shunt.

 If a CVC is not placed correctly, it may result in complications including bleeding, pneumothorax and potentially death. We describe the placement of a left sided CVC in the presence of a ventriculo-atrial (VA) shunt on the right side, using a technique that minimized the risk to the shunt and the patient.  A CVC was chosen in this case due to the potential need for monitoring of hemodynamics and high volume of resuscitation through a secure access point.