title: Dilemma with the route of venous access for hemodialysis catheter insertion in a patient with dilated ischemic cardiomyopathy treated by cardiac resynchronization therapy.
abstract: A 68 year old patient requiring urgent dialysis due to raising potassium was referred to our center. He had 3 indwelling catheters in his heart via right subclavian vein. His left subclavian and interngal jugular veins were thrombosed possibly due to earlier indwelling catheters. The dilemma was if right internal jugular venous route could be used for insertion of dialysis catheter. Under fluoroscopic guidance, right internal jugular vein was cannulated with the dialysis catheter without problems. This case is being presented to highlight the need for imaging both by ultrasound and radiography during the procedure.
authors.affiliation: Department of Anesthesia, Consultant Anesthesiologist, Critical Care and Pain Relief, Fortis Hospitals, Bannerghatta Road, Bangalore, Karnataka, India.
authors.forename: Devanahalli
authors.initials: D
authors.lastname: Ashokananda
authors.affiliation: Department of Anesthesia, Consultant Anesthesiologist, Critical Care and Pain Relief, Fortis Hospitals, Bannerghatta Road, Bangalore, Karnataka, India.
authors.forename: Murali
authors.initials: M
authors.lastname: Chakravarthy
authors.affiliation: Department of Anesthesia, Consultant Anesthesiologist, Critical Care and Pain Relief, Fortis Hospitals, Bannerghatta Road, Bangalore, Karnataka, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Gowda
authors.affiliation: Department of Anesthesia, Consultant Anesthesiologist, Critical Care and Pain Relief, Fortis Hospitals, Bannerghatta Road, Bangalore, Karnataka, India.
authors.forename: Pavani
authors.initials: P
authors.lastname: Maddirala
authors.affiliation: Department of Anesthesia, Consultant Anesthesiologist, Critical Care and Pain Relief, Fortis Hospitals, Bannerghatta Road, Bangalore, Karnataka, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sripar
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D009202:Cardiomyopathies / Q000150:complications* / Q000628:therapy; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications* / Q000628:therapy; D013902:Radiography, Thoracic; D006435:Renal Dialysis / Q000295:instrumentation*; D014463:Ultrasonography