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).