Dialysis catheter placement via the left internal jugular vein: risk of brachiocephalic vein perforation

Michiel B. Winkes*, Maarten J. Loos, Marc R. Scheltinga, Joep A. Teijink

*Corresponding author for this work

Research output: Contribution to journalEditorialAcademicpeer-review


Purpose: We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio (R) central venous catheter insertion. Method and results: An 80-year-old patient underwent an ultrasound-guided hemodialysis (HD) catheter placement via his left internal jugular vein (IJV). One day postoperatively, the patient became hemodynamically unstable immediately after HD initiation. As a vascular event was feared, an emergency CT scan was performed demonstrating a BCV perforation. The patient underwent a sternotomy, the lines were removed and the venous laceration was closed. The patient recovered well. Conclusions: In spite of ultrasound guidance, fluoroscopy for guidewire and sheath advancement, venous blood aspiration and a normal appearing postoperative x-ray, traumatic central venous catheter placement is still possible. Tenting of the BCV wall during catheter advancement possibly caused the venous perforation. A 'how-to' for correct catheter placement via the IJV is provided and potential pitfalls during each procedural step are discussed.
Original languageEnglish
Pages (from-to)E75-E78
JournalJournal of vascular access
Issue number4
Publication statusPublished - 2016


  • Brachiocephalic vein
  • Central venous catheter insertion
  • Internal jugular vein
  • Perforation
  • Tesio (R) catheters


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