title: Hemodialysis catheter insertion: is increased PO2 a sign of arterial cannulation? A case report.
abstract: BACKGROUND
  Ultrasound-guided Central Venous Catheterization (CVC) for temporary vascular access, preferably using the right internal jugular vein, is widely accepted by nephrologists. However CVC is associated with numerous potential complications, including death. We describe the finding of a rare left-sided partial anomalous pulmonary vein connection during central venous catheterization for continuous renal replacement therapy (CRRT).
  
  
  METHODS
  Ultrasound-guided cannulation of a large bore temporary dual-lumen Quinton-Mahurkar catheter into the left internal jugular vein was performed for CRRT initiation in a 66 year old African-American with sepsis-related oliguric acute kidney injury. The post-procedure chest X-ray suggested inadvertent left carotid artery cannulation. Blood gases obtained from the catheter showed high partial pressure of oxygen (PO2) of 140 mmHg and low partial pressure of carbon dioxide (PCO2) of 22 mmHg, suggestive of arterial cannulation. However, the pressure-transduced wave forms appeared venous and Computed Tomography Angiography located the catheter in the left internal jugular vein, but demonstrated that the tip of the catheter was lying over a left pulmonary vein which was abnormally draining into the left brachiocephalic (innominate) vein rather than into the left atrium.
  
  
  CONCLUSIONS
  Although several mechanical complications of dialysis catheters have been described, ours is one of the few cases of malposition into an anomalous pulmonary vein, and highlights a sequential approach to properly identify the catheter location in this uncommon clinical scenario.
authors: Department of Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas, USA. jchirinos82@hotmail.com.
authors: Julio C
authors: JC
authors: Chirinos
authors: Javier A
authors: JA
authors: Neyra
authors: Jiten
authors: J
authors: Patel
authors: Aylin R
authors: AR
authors: Rodan
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood*; D010313:Partial Pressure; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*
chemical_list: D010100:Oxygen