Cause for inadequate clearance: hemodialysis catheter migration into the coronary sinus

Complications associated with central dialysis catheters prove to be an important source of morbidity that challenge patients and clinicians alike. While thrombosis, stenosis, and infection remain the most common threats to functioning central dialysis catheters, malposition of such devices may similarly result in serious consequences. Despite advanced techniques used to confirm initial catheter placement, the very nature of these catheters entails frequent manipulation for vascular access and therefore they may migrate after repeated use. When compared with the loss of patency and infection, complications involving malposition or migration may present in a more insidious fashion, such as a gradual decline in achievable blood flow rate or observed clearance over time. We describe a patient who acutely developed both clinical and biochemical evidence of inadequate clearance after several months of suboptimal catheter function. When the central dialysis catheter was examined fluoroscopically, it was found to have migrated into the coronary sinus.