Unusual placement of a dialysis catheter: Persistent left superior vena cava

Many nephrologists perform clinical procedures, and perhaps the most common is placement of a noncuffed dialysis catheter to obtain vascular access necessary for immediate hemodialysis therapy. The right internal jugular vein frequently is the site of choice for placement of such catheters in most patients, but placement in the left internal jugular vein would not be unusual; for example, if another central catheter is present in the right internal jugular vein or there has been a failed attempt at that site. Nephrologists who place hemodialysis catheters in the left internal jugular vein should be aware of the existence of an anatomic variant, a persistent left superior vena cava, to prevent alarming misinterpretation and inappropriate clinical responses to routine chest radiographs taken to confirm adequate placement of such catheters.