Right axillary vein thrombosis due to malpositioning of a central venous catheter via the internal jugular vein

Corresponding author: Jae Jun Lee, M.D., Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 153, Kyo-dong, Chuncheon 200-704, Korea. Tel: 82-33-240-5594, Fax: 82-33-251-0941, E-mail: [email protected] This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. CC Central venous catheterization (CVC) is commonly used in the operative setting for central venous pressure monitoring, drug administration, and the rapid introduction of fluids. However, CVC can have many severe complications, even for experi enced physicians. Furthermore, complications of CVC are increasingly being recognized as a major source of morbidity. We report a rare, but serious, case of right axillary vein thrombosis due to malpositioning of a central venous catheter tip following right internal jugular venous (IJV) catheterization. A 67­year­old, 40­kg, 158­cm­tall female with cholangio­ cellular carcinoma of the liver required CVC. With the patient supine, the neck was prepped and draped sterilely. The position of the IJV was determined using a 7.5­MHz linear ultrasound probe (M­Turbo; SonoSite, Bothell, WA, USA) and ultrasound (MicroMaxx; SonoSite). A central venous catheter (Two­Lumen Central Venous Catheterization Set with Blue FlexTip; Arrow, Reading, PA, USA) was advanced into the IJV. Subsequently, the aspiration of blood via the two lumens of the catheter was observed, and the catheter was secured at a depth of 15 cm below the skin. On connecting the transducer to the monitor,