Echocardiography-Guided Repositioning of a Hemodialysis Catheter in a Patient With Persistent Left Superior Vena Cava: A Case Report

TL;DR

This case report describes using echocardiography to safely reposition a dialysis catheter in a patient with a rare vein anomaly.

Contribution

Demonstrates the use of transthoracic echocardiography for real-time catheter repositioning in a persistent left superior vena cava.

Findings

Transthoracic echocardiography confirmed the catheter tip was near the coronary sinus, risking cardiac perforation.

Catheter repositioning under TTE guidance allowed for nine days of complication-free hemodiafiltration.

TTE is a safe and effective alternative to fluoroscopy for catheter placement in critically ill patients with PLSVC.

Abstract

Persistent left superior vena cava (PLSVC) is an uncommon thoracic venous anomaly that is often identified incidentally during central venous access or thoracic imaging. We describe a case in which transthoracic echocardiography (TTE) was used to safely and effectively reposition a hemodialysis catheter within a PLSVC to enable continuous hemodiafiltration (CHDF). A 71-year-old man developed septic shock complicated by acute kidney injury requiring CHDF. Because vascular access options were limited, a dialysis catheter was inserted via the left internal jugular vein. Imaging revealed that the catheter was located within a PLSVC, and TTE demonstrated that the catheter tip was positioned near the coronary sinus, raising concern for potential cardiac perforation. Under real-time TTE guidance at the bedside, the catheter was withdrawn several centimeters to a safer position. CHDF was subsequently performed for nine days without complications, maintaining a stable blood flow rate. TTE is a valuable bedside tool for confirming and adjusting catheter position in a PLSVC, particularly in critically ill patients who are unsuitable for fluoroscopic imaging.

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