Perforation of the internal jugular vein during cannulation for haemodialysis

BACKGROUND: Reliable temporary vascular access is necessary for haemodialysis when the establishment of permanent access is not possible. Double-lumen catheters are favoured in most cases. These catheters are commonly inserted percutaneously using anatomic landmarks, but the technique is far from being perfect and serious complications may occur during the procedure. We describe a serious and potentially lethal complication of internal jugular venous cannulation. CASE REPORT: A 50-year-old woman was transferred from another hospital because of misplacement of a tunnelled permanent haemodialysis catheter and internal bleeding. A computed tomographic angiogram of the chest revealed that the catheter had migrated to the mediastinum. Emergency surgery with cardiopulmonary bypass was performed, the catheter removed, and the damaged left internal jugular and right subclavian veins were reconstructed. CONCLUSION: Migration of a dialysis catheter outside the vascular bed is a potentially lethal complication. Removal of a misplaced catheter may lead to massive uncontrolled bleeding and should be managed surgically.