A case in which a pulmonary artery catheter inserted via the right internal jugular vein became stuck and bent in the right subclavian vein.

Abstract

　A 64-year-old man was scheduled for the removal of a left atrial myxoma. After tracheal intubation, we attempted to insert a pulmonary artery catheter (PAC) from the right internal jugular vein, but there was resistance after the PAC advanced 20 cm. When the PAC was pushed more strongly, the insertion successfully continued to 50 cm, but the right ventricular pressure could not be confirmed. We then pulled the PAC to remove it, but there was a strong resistance at about 40 cm. We performed chest radiography to confirm the location of the PAC, which revealed that the PAC entered from the right internal jugular vein into the right subclavian vein, thus it was bent in the axillary region, with the tip located in the superior vena cava. The PAC was subsequently pulled out of the operation field during cardiopulmonary bypass. Overall, to prevent the PAC from getting stuck, it should not be forcibly pushed during its insertion when resistance is encountered, and fluoroscopic guidance should be considered as an aid.