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Management of a malpositioned central venous catheter in the accessory hemiazygos vein
  1. Yuki Izumi1,
  2. Ivor Cammack2 and
  3. Takeshi Yokoyama1
  1. 1Anesthesiology and Critical Care, Teine Keijinkai Hospital, Sapporo, Japan
  2. 2Cammack & Evans Surgery, Wellington, New Zealand
  1. Correspondence to Dr Yuki Izumi; izumi-yu{at}


Malposition of a central venous catheter (CVC) in the accessory hemiazygos vein is an uncommon but potentially fatal complication; however, there is limited information regarding the preferred removal technique. We report a patient, a 57-year-old woman, who presented with overdose of her prescribed sedatives, who experienced this catheter complication after CVC insertion in the left internal jugular vein. The CVC was placed without resistance but routine postplacement chest X-ray showed abnormal coursing of the catheter close to the descending aorta. We used non-enhanced CT as an adjunct to safely identify the catheter position and assess for any bleeding during removal. CT images taken after retraction of the catheter tip by 10 cm showed no bleeding and we were able to remove the catheter safely. We recommend using CT as an adjunct to safely remove malpositioned catheters and reduce the risk of further complication.

  • adult intensive care
  • anaesthesia
  • emergency medicine

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  • Contributors YI and IC made substantial contributions to conception and design, acquisitions of data and analysis and interpretation of data. TY analysed the patient data. All authors have given final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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