Misplaced Internal Juglar Vein Central Venous Catheter due to Thrombosis in Subclavian Vein: A Rare Occurrence

Here, authors report a case of Central Venous Catheter (CVC) malposition in a patient posted for Whipple's procedure. A 65-yearold male diagnosed with carcinoma head of pancreas, post-chemotherapy was posted for Whipple's procedure. Ultrasound (USG) guidance CVC line and arterial cannula placement were planned for invasive monitoring and administration of fluids and drugs postoperatively. A post-operative chest radiograph was done which showed that the CVC was malpositioned into the subclavian vein. The venography delineated a clot at the junction of the Internal Jugular Vein (IJV) and the Subclavian Vein (SCV). It was further concluded that presence of this thrombus at the junction of both the vessels prevented the movement of the guidewire towards the Superior Vena Cava (SVC) and therefore the catheter into the SVC. This case report highlights the use of USG not only to visualise the target vessel but also to scan completely till the junction SVC and right atrium for any clot or anatomic malformations in the vasculature.