Aberrant position of a central venous catheter: a cause for inadequate fluid replacement in septic shock.
An unusual placement of a "central" venous catheter in the porto-hemiazygous system of a cirrhotic patient in septic shock is described. The catheter was misinterpreted as being located in a central vein and served initially as a guide for volume replacement. The high central venous pressure recorded (22 cm H2O) in spite of signs of hypovolemia led to the introduction of a Swan-Ganz catheter which confirmed the presence of hypovolemia. The proper position of the central venous catheter, especially in cirrhotic patients, should not only be confirmed by plain chest x-ray but also by injection of contrast medium.
D000328:Adult; D002404:Catheterization / Q000592:standards*; D002496:Central Venous Pressure; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007263:Infusions, Parenteral / Q000295:instrumentation*; D008103:Liver Cirrhosis / Q000628:therapy; D012772:Shock, Septic / Q000628:therapy*