CASE REPORT: Fluoroscopy-Guided Repositioning of Malposition Central Venous Catheter During Cardiac Surgery: A Case Report

Abstract

ABSTRACT
Central venous catheter (CVC) malposition remains a recognized complication, even with ultrasound-guided insertion, and may not be detected by routine functional assessment. We present a case involving a 61-year-old male patient undergoing elective coronary artery bypass grafting, in which a right internal jugular vein CVC exhibited selective distal lumen dysfunction after insertion. Although three lumens were aspirated and flushed normally, the inability to aspirate blood from the distal lumen suggested catheter malposition. Fluoroscopic
imaging confirmed the deviation of the catheter tip into the ipsilateral subclavian vein. The catheter was successfully repositioned under fluoroscopic guidance by withdrawing it with continuous aspiration, followed by saline-assisted re-advancement, which restored full lumen function. In this patient, fluoroscopic repositioning eliminated the need for repeatcannulation and its associated procedural risks. This case underscores that the normal function of some catheter lumens does not preclude malposition and that selective distal lumen dysfunction should prompt early imaging confirmation and corrective intervention.