Sanjith Saseedharan, Rahul Pandit, Sunil Bhargava.
Left internal jugular vein dissection with anterior mediastinal placement following hemodialysis catheter insertion.
J Pak Med Students Jan ;2(4):134-7.

We report a case of a 68-year-old woman with end stage renal disease in whom the placement of ultrasound-guided left internal jugular vein hemodialysis catheter was extraluminal. Slight flow restriction was noted through the arterial side of the catheter towards the end of the hemodialysis session and subsequent CT scan and venography revealed extraluminal placement of the line with probable clotting of the distal tip. The line was removed carefully and was replaced with a longer catheter bypassing the rent in the lumen of the left brachiocephalic vein. Although dissection of the internal jugular vein during hemodialysis cannulation is a rare complication, physicians who place these catheters should be careful. Higher incidence of complications has been reported with left internal jugular vein and it should not be the first preference. The placement of the catheter and location of its tip should always be confirmed with a radiograph or by fluoroscopy.

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