Newly Published
Images in Anesthesiology  |   April 2019
Central Venous Catheter in the Internal Mammary Vein
Author Notes
  • From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California.
  • Correspondence: Address correspondence to Dr. House: mclean.house@ucsf.edu
Article Information
Images in Anesthesiology / Technology / Equipment / Monitoring
Images in Anesthesiology   |   April 2019
Central Venous Catheter in the Internal Mammary Vein
Anesthesiology Newly Published on April 10, 2019. doi:10.1097/ALN.0000000000002702
Anesthesiology Newly Published on April 10, 2019. doi:10.1097/ALN.0000000000002702
Left-sided central venous catheterization has several pitfalls. Malposition may occur despite proper insertion technique. Pictured here, a multilumen access catheter (sheath) with triple-lumen insert was placed by Seldinger technique after left internal jugular vein puncture. While initially freely mobile, the J-tip guidewire encountered resistance at 20 cm depth. The catheter advanced smoothly over the guidewire after dilation. Once secured, two distal ports would not aspirate; the remaining ports aspirated blood. A central venous waveform was transduced from the functioning ports, which were infused without complication. Chest radiography (A) reveals the sheath position (arrowheads) with catheter tip (blue arrow) below the clavicle, concerning for abnormal intravascular versus intrapleural placement. Sternotomy wires, prosthetic valves, left pleural effusion, and an aortic (Ao) stent graft are also visualized. Computed tomography angiography demonstrates cannulation of the left internal mammary vein without vessel injury (B, axial; C, sagittal). The catheter runs alongside the left internal mammary artery (red arrows).