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  Table of Contents  
Year : 2015  |  Volume : 25  |  Issue : 6  |  Page : 384-385

Misplaced tunneled catheter into azygos vein

Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India

Date of Web Publication28-Oct-2015

Correspondence Address:
K Sampathkumar
36, Radhakrishnan Street, Bibikulam, Madurai - 625 002, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-4065.147767

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How to cite this article:
Sampathkumar K, Prabhakar A, Saravanan R, Nayak M A. Misplaced tunneled catheter into azygos vein. Indian J Nephrol 2015;25:384-5

How to cite this URL:
Sampathkumar K, Prabhakar A, Saravanan R, Nayak M A. Misplaced tunneled catheter into azygos vein. Indian J Nephrol [serial online] 2015 [cited 2020 Nov 23];25:384-5. Available from:

Tunneled cuffed internal jugular vein catheters (TCC) are frequently used for hemodialysis. The procedure should ideally be undertaken under fluoroscopic image guidance, but many nephrology units do not have access to such facility. Anatomical landmark guided blind insertion is carried out in such a situation.

A 36-year-old man was initiated on maintenance HD. Under local anesthesia with aseptic precautions, a TCC was introduced into right internal jugular vein by anatomical landmark guidance. A check chest X-ray revealed that the tip of the TCC was unusually curved [Figure 1]. In a fluoroscopy suite, contrast was injected into the venous limb of the TCC. It showed that the catheter tip was in the azygos vein at the posterior mediastinum [Figure 2]. The TCC was pulled up into superior vena cava (SVC). A guidewire was inserted through the catheter. After confirming the position of the guidewire in the inferior vena cava, TCC was positioned at mid right atrium [Figure 3]. Adequate blood flow could be achieved for HD.
Figure 1: Arrows follow the curved tip of tunneled cuffed catheter

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Figure 2: Lateral fluoroscopic view. Black arrow shows tunneled cuffed catheter in posterior mediastinum. White arrow shows dye entering Azygos vein

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Figure 3: Arrow shows tip of repositioned tunneled cuffed catheter at junction of superior vena cava and right atrium

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Azygos vein courses in the posterior mediastinum from abdomen to empty into SVC with wide variation in its anatomical position, tributaries, and course.[1] The size of its opening into SVC can vary between of 4 and 16 mm. The vein enlarges in state of venous congestion as in chronic kidney disease with cardiac failure.[2] This may permit the tip of TCC to enter the vein. Lateral chest X-ray will reveal the catheter to be placed in the posterior mediastinum.[3] Serious hemorrhage and hemothorax have been encountered due to such misplacement.[4] Use of fluoroscopy could have prevented this occurrence.

  References Top

Tatar I, Denk CC, Celik HH, Oto A, Karaosmanoglu DA, Ozdemir BM, et al. Anatomy of the azygos vein examined by computerized tomography imaging. Saudi Med J 2008;29:1585-8.  Back to cited text no. 1
Calviño J, Bravo J, Martínez L, Millán B, Pulpeiro JR. Recognizing misplacement of a dialysis catheter in the azygos vein. Hemodial Int 2013;17:455-7.  Back to cited text no. 2
Haygood TM, Brennan PC, Ryan J, Yamal JM, Liles L, O'Sullivan P, et al. Central venous line placement in the superior vena cava and the azygos vein: Differentiation on posteroanterior chest radiographs. AJR Am J Roentgenol 2011;196:783-7.  Back to cited text no. 3
Currarino G. Migration of jugular or subclavian venous catheters into inferior tributaries of the brachiocephalic veins or into the azygos vein, with possible complications. Pediatr Radiol 1996;26:439-49.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3]


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Indian Journal of Nephrology
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Online since 20th Sept '07