Vascular access challenge


Intravenous literature: Leung, S., Malhotra, A.D. and Eisen, L.A. (2010) Vascular access challenge on a patient with cerebral palsy and severe kyphoscoliosis. Journal of Vascular Access. 11(1), p.66-8.


We report a case of vascular assess challenge on a patient with severe kyphoscoliosis and joint contractures. Multiple internal jugular (IJ) central venous catheters (CVC) and a peripherally inserted central catheter (PICC) catheterization were attempted via ultrasound guidance and all resulted in malposition. The PICC attempt fortuitously pushed a malpositioned IJ into the correct position. Computed tomography (CT) demonstrated a narrow thoracic inlet with no definite venous stenoses. Therefore, severe chest wall deformity, a narrow thoracic inlet and inadequate positioning of the patient secondary to his contractures all contributed to the malposition of the PICC and CVCs.


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