Central venous cannulation although a popular and safe technique is known to be associated with complications. Malposition of central venous catheter is one such complication which can occur.1 This is a case report on a misdirected central venous catheter into opposite internal jugular vein (IJV) following subclavian vein cannulation. Introduction Central venous cannulation is a popular and widely practiced technique used for various purposes in anaesthesia and intensive care. Widely regarded as a safe technique it can yet be associated with many complications. Malposition of central venous catheter (CVC) is a (not unusual) known complication.1 There are many case reports on malposition of CVC into ipsilateral internal jugular vein(IJV) following subclavian vein cannulation and is regarded as a common complication.2 However the misplacement of CVC into contralateral IJV is extremely rare. We report a case of malposition of CVC tip into left IJV following right subclavian vein cannulation. Case presentation A 70 year old woman with acute intestinal obstruction (due to rectosigmoid growth) presented to operating room for emergency transverse colostomy. On examination she was grossly dehydrated, Pulse-140bpm, BP-140/70mmHg, cold peripheries. Central venous cannulation was considered as the peripheral veins appeared collapsed and were inaccessible. Under aseptic precautions, the right subclavian vein was successfully cannulated with 7 French triple lumen CVC ( B Braun) by infraclavicular approach using Seldinger’s technique. No abnormal resistance was offered to the insertion of guide wire, nor the catheter. Catheter was fixed after confirmation of free aspiration of venous blood in all the ports as well as free flow of normal saline. Rapid sequence induction was followed and the surgery was commenced. Intraoperative period was uneventful. Postoperatively a check chest X-ray revealed the catheter tip position in the contralateral (Left) IJV. ( Figure1)
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