Central venous catheter (CVC) placement is an essential component of critical care medicine. CVC malposition is a known complication of internal jugular vein (IJV) cannulation. However, catheterization of the internal thoracic vein (ITV) is much rarer. Only a handful of case reports have been documented, and guidelines for management are therefore lacking. Our case study describes this rarely occurring ITV cannulation along with the discussion of risk factors, warning signs of malpositioning, and subsequent management plans to optimize patient safety. Previous studies have used fluoroscopy and agitated saline flush tests to confirm that agents administered through an ITV-located catheter would reach the right atrium. Considering this, it would follow that a catheter in this site could theoretically be used for medication administration, especially in emergency settings. This hypothesis remains the most novel part of our case study and might prompt further exploration of management strategies in this particular situation.
Reference:Goodin P, Jain N, Jeelani HM, Bharat A. Accidental Central Venous Catheter Placement in the Internal Thoracic Vein: A Case Report. Cureus. 2020;12(7):e9255. Published 2020 Jul 18. doi:10.7759/cureus.9255