Anesth Pain Med.  2023 Jan;18(1):46-50. 10.17085/apm.22212.

Secondary migration of a pre-existing central venous catheter due to a Swan-Ganz catheter insertion – A case report –

• Cho J
• Yoo BH
• Park J
• Lim YH
• Jun Ij
• Kim Km

• KMID: 2540333
• DOI: http://doi.org/10.17085/apm.22212

Abstract

Background
The entanglement of multiple central venous catheters is a rare and seriouscomplication. The Swan-Ganz catheter is a responsible for various cases.Case: A 66-year-old male patient was under general anesthesia for a coronary artery bypassgraft surgery. As he had a pre-existing Perm catheter in the right subclavian vein, a SwanGanz catheter was inserted into the left internal jugular vein. Chest radiograph after catheterplacement revealed that the Perm catheter had migrated to the left brachiocephalic vein.The surgeon attempted to reposition it manually, but postoperative radiograph showed thatit had rolled into a loop. On postoperative day 1, radiological intervention was performed tountangle the loop, which was successful.Conclusions: After placing a Swan-Ganz catheter in patients with a pre-existing central venous catheter, the presence of entanglement should be assessed. In such cases, radiology-guided correction is recommended, as a blind attempt to disentangle can aggravate thecondition.

Keyword

Anesthesia, cardiac procedures; Catheters, indwelling; Catheterization, Swan-Ganz; Central venous catheters; Equipment failure; Intraoperative complications

Figure

• 

  Fig. 1. Preoperative chest radiograph with Perm catheter tip in place (black arrow).

• 

  Fig. 2. Intraoperative chest radiograph after Swan-Ganz catheter insertion. The mid to distal portion of Perm catheter was positioned in the left brachiocephalic vein, with a flexure in the middle and the tip in superior vena cava (black arrow).

• 

  Fig. 3. Postoperative chest radiograph showing intraoperative manual repositioning of Perm catheter had resulted in looping of the catheter tip (black arrow).

• 

  Fig. 4. Chest radiograph after successful radiologic procedure to reposition the Perm catheter, showing the tip back in the original place (black arrow).

Reference

1. Bossert T, Gummert JF, Bittner HB, Barten M, Walther T, Falk V, et al. Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery. J Card Surg. 2006; 21:292–5.

2. Evans DC, Doraiswamy VA, Prosciak MP, Silviera M, Seamon MJ, Rodriguez Funes V, et al. Complications associated with pulmonary artery catheters: a comprehensive clinical review. Scand J Surg. 2009; 98:199–208.

3. Bagul NB, Menon NJ, Pathak R, Platts A, Hamilton G. Knot in the cava--an unusual complication of Swan-Ganz catheters. Eur J Vasc Endovasc Surg. 2005; 29:651–3.

4. Graff J, Gong R, Byron R, Hassett JM. Knotting and entanglement of multiple central venous catheters. JPEN J Parenter Enteral Nutr. 1986; 10:319–21.

5. Kranz A, Mundigler G, Bankier A, Daneschvar H, Pacher R, Siostrzonek P. Knotting of two central venous catheters: a rare complication of pulmonary artery catheterization. Wien Klin Wochenschr. 1996; 108:404–6.

6. Diez Balda V, Rubio JJ, Dominguez de villota E, de la Serna JL, Roig M, Galdos P. Intracardiac knotting of two catheters: an unusual hazard of pulmonary artery catheterization. Intensive Care Med. 1982; 8:299–300.

7. Swaroop S. Knotting of two central venous monitoring catheters. Am J Med. 1972; 53:386–8.

8. Hida S, Ohashi S, Kinoshita H, Honda T, Yamamoto S, Kazama J, et al. Knotting of two central venous catheters: a rare complication of pulmonary artery catheterization. J Anesth. 2010; 24:486–7.

9. Wilson J, Freeman R. A knotty problem with two central venous catheters. Anaesthesia. 1992; 47:815.

10. Gold A, Kiefer J, Priem E, Augoustides JG. A rare and unique central line complication. J Cardiothorac Vasc Anesth. 2021; 35:676–7.

11. Rao PB, Singh N, Samson S. Central venous catheter malposition due to dialysis catheter: a case report. Korean J Anesthesiol. 2016; 69:532–4.

12. Georghiou GP, Vidne BA, Raanani E. Knotting of a pulmonary artery catheter in the superior vena cava: surgical removal and a word of caution. Heart. 2004; 90:e28.

13. Castellá M, Riambau V, Palacin J, Font C, Mulet J. True knot in a Swan-Ganz catheter on a central venous catheter: a simple trick for percutaneous removal. Intensive Care Med. 1996; 22:830–1.