title: Vascular access challenge on a patient with cerebral palsy and severe kyphoscoliosis.
abstract: We report a case of vascular assess challenge on a patient with severe kyphoscoliosis and joint contractures. Multiple internal jugular (IJ) central venous catheters (CVC) and a peripherally inserted central catheter (PICC) catheterization were attempted via ultrasound guidance and all resulted in malposition. The PICC attempt fortuitously pushed a malpositioned IJ into the correct position. Computed tomography (CT) demonstrated a narrow thoracic inlet with no definite venous stenoses. Therefore, severe chest wall deformity, a narrow thoracic inlet and inadequate positioning of the patient secondary to his contractures all contributed to the malposition of the PICC and CVCs.
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Leung
authors.forename: Amit D
authors.initials: AD
authors.lastname: Malhotra
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Eisen
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002547:Cerebral Palsy / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007601:Jugular Veins; D007738:Kyphosis / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D056888:Patient Positioning; D012600:Scoliosis / Q000150:complications* / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D013350:Subclavian Vein; D035441:Thoracic Wall / Q000002:abnormalities; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional; D055815:Young Adult