We report the case of a female patient admitted to the Intensive Care Unit (ICU) with pre-syncopal symptoms and frequent ventricular extrasystoles following recent orthopedic surgery for an ankle fracture complicated by cellulitis due to surgical wound infection. Fourteen days after hospital discharge, the patient was admitted for monitoring, and a central venous catheter (CVC) with three lumens, 60 cm in length (7 Fr) inserted in the antecubital region was placed with the intention of directing it toward the superior vena cava for the administration of fluids and antibiotics. A subsequent computed tomography (CT) angiography was performed to rule out pulmonary thromboembolism, with a negative radiological report. On the third day, significant phlebitis of the left arm was observed, attributed to the CVC becoming lodged above the arm’s flexural crease. A chest X-ray taken after the catheter insertion revealed that it did not follow the correct trajectory toward the superior vena cava; instead, it descended in an atypical descending course. A further review of the CT angiography confirmed that the catheter had deviated from its intended course and was positioned in the dorsal scapular vein.
The catheter was removed promptly, and a new CVC was successfully placed in the left subclavian vein.
Santiago Herrero, Nataly Parra
