A misplacement of the supraclavicular approach of subclavian vein catheterization into the neck under ultrasound guidance and electrocardiogram-guided confirmation technique: A case report

Subclavian vein catheterization is commonly done in the management of critically ill patients. Nevertheless, a supraclavicular approach of subclavian vein catheterization appears safer in comparison to the infraclavicular approach. Here, we present a case of misplacement of subclavian vein catheterization into the right neck when inserted via supraclavicular approach under ultrasound guidance and confirmed by the electrocardiogram guided technique in a critically ill 65-year-old male who planned for emergency midline laparotomy. Hemodynamically, he was supported by a high vasopressor from the emergency department, and the subclavian venous catheterization via supraclavicular approach was inserted under ultrasound guidance and there was a rhythm change on the electrocardiogram. However, repeated chest X-rays showed a misplacement of the catheter into the right neck and we removed the central lumen immediately. In conclusion, despite using a supraclavicular approach under ultrasound guidance and reliance upon electrocardiogram-guided technique confirmation, a misplacement of the catheter still occurs especially in hemodynamically unstable patients. We believe that real-time monitoring while advancing the guidewire during insertion may prevent this incidence in the future and repeated chest X-ray post central venous catheterization is a must when applicable. Keywords: Catheterization, central venous, electrocardiogram-guided, misplacement, subclavian vein, supraclavicular