Case:
A 13 years child with end stage renal disease was brought to our facility to undergone a tunneled hemodialysis catheter. The patient was switched to hemodialysis after peritoneal dialysis failure.
Several attempts to create a native arteriovenous fistula were done without success, and the patient undergone several short term catheters to have hemodialysis sessions.
The patient has seven years follow up by the pediatricians for his NPHP. The diagnostic was done by clinical and radiological evidence. The detection of compound heterozygous or homozygous mutations in a gene contributing to NPHP is not available in the country.
Clinical assessments found: cerebral ataxia, developmental delay, and a dextrocardia at the chest x-ray. Echocardiography showed classic mirror dextrocardia without associated malformations.
The patient was placed in an operating room. The procedure has been done under general anesthesia guided by fluoroscopy and contrast injection. The central vein puncture was done by ultrasound guidance. After needling the left internal jugular vein, the guide wire could not reach the cardiac atrium and it was mislocated in the left subclavian vein (Fig 1).
The angiography of the chest left side has shown: a thrombosed jugular vein, a thrombosed subclavian vein and a thrombosed brachiocephalic vein followed by a free LSVC and a left azygos vein (Fig 2). The angiography of the chest right side has shown: a free jugular vein and a free brachiocephalic vein (Fig 3). A hydrophilic guide wire has been placed in the left cardiac atrium guided by fluoroscopy through the right internal jugular vein.
A 12 french double lumen tunneled hemodialysis catheter was placed with an accurate tip catheter position in the cardiac atrium. (Fig 4).