Placement of long term central venous access devices (CVAD) such as chemo ports and Hickman's catheters are associated with a definite risk of catheter tip malpositioning. As such, malpositioning runs a risk of venous thrombosis and related complications; it is imperative to reposition the catheter. Percutaneous transfemoral venous approach has been described as a minimally invasive and safe me...

T he article by Fragou et al (1), in this month’s Critical Care Medicine, provides compelling evidence that the routine use of ultrasound guidance increases the safety of central venous access by the subclavian route. In this cohort of critical care patients, cannulation was achieved in 100% of patients in the ultrasound group as compared with 87.5% in the landmark arm. Access time and the numb...

To cite: Ryan JW, Murphy A, Wrafter S, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2016-218238 DESCRIPTION A young man in his early 30s presented with a 3-day history of left upper arm swelling and erythema (figure 1). He had no significant medical history. Of note he had a strong family history of deep venous thrombosis (DVT) with both parents having ...

Central venous catheterization (CVC) can be difficult, especially with pediatric patients in critical care. Accessing the subclavian vein (SCV) can cause serious complications, including pneumothorax, arterial puncture, and hemothorax. Recently, the ultrasonographic (USG) technique has gained popularity, but its efficiency is not yet confirmed. Subclavian venous catheterization (SCVC) through t...

We present the case of a 46-year old male patient suffering from non-ischemic cardiomyopathy and intermittent atrial tachycardia. According to guidelines an implantable cardioverter defibrillator (ICD) was planned to implant through the left subclavian vein. During the procedure the angiography revealed a persistent left superior vena cava (PLSVC) with moderate stenosis of the subclavian vein. ...

During routine dissection in the department of anatomy, the following anatomical variations of the phrenic nerve were observed on the right side of the neck of a 30-year-old male cadaver. The phrenic nerve, in its early course close to its origin, gave a communicating branch to the C5 root of the brachial plexus. At the level of the root of neck just before entering the thorax, the phrenic nerv...

Central venous stenosis or occlusion occurs in 11-50% of hemodialysis patients with prior subclavian vein cannulation and ipsilateral fistula or shunt. Most patients are asymptomatic but some require treatment to reduce the risk of thrombosis and improve inadequate hemodialysis pressure. In these cases, endovascular intervention, including ballooning and stenting, is a feasible strategy for sel...

INTRODUCTION Clinicians use either direct or indirect (Seldinger) techniques for internal juguler or subclavian vein catheterization. This report aims to point out that the success rate of the direct technique where the catheter is inserted directly through the cannula may be higher particularly in catheterization of pediatric cases. CASE PRESENTATION A 7.5-month-old female infant weighing 72...

We read with interest the work by Saugel et al. [1] about ultrasound-guided central venous catheter placement. In their work the authors accurately describe “in-plane” and “out of plane” techniques for central venous catheter access. However, they describe only briefly the oblique-axis technique and for this approach only articles about internal venous jugular catheterization are cited [2, 3] a...

Superior mediastinum contains many important vessels and tubes, variation of one may affect the other. Left brachiocephalic vein crosses arch of the aorta and its branches superficially. Arch of the aorta from its convex superior aspect usually provides brachiocephalic, left common carotid and left subclavian artery from the right to left. Left subclavian artery continues as axillary artery and...