Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2023; 11(34): 8200-8204
Published online Dec 6, 2023. doi: 10.12998/wjcc.v11.i34.8200
Thoracic duct cannulation during left internal jugular vein cannulation: A case report
Geal Hong Hwang, Woosik Eom
Geal Hong Hwang, Woosik Eom, Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
Author contributions: Hwang GH and Eom W were the physicians; Hwang GH reviewed the literature and contributed to manuscript drafting; Hwang GH and Eom W were responsible for the revision of the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient’s parents for publication of any accompanying images in the case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Woosik Eom, MD, PhD, Doctor, Department of Anesthesiology and Pain Medicine, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Gyeonggi-do, South Korea. uchic@ncc.re.kr
Received: September 24, 2023
Peer-review started: September 24, 2023
First decision: October 24, 2023
Revised: October 31, 2023
Accepted: November 28, 2023
Article in press: November 28, 2023
Published online: December 6, 2023
Processing time: 72 Days and 18.6 Hours
Abstract
BACKGROUND

Central venous catheter insertion is an invasive procedure that can cause complications such as infection, embolization due to air or blood clots, pneumothorax, hemothorax, and, rarely, chylothorax due to damage to the thoracic duct. Herein, we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion. Fortunately, the patient was discharged without any adverse events related to thoracic duct cannulation.

CASE SUMMARY

A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. During anesthesia, we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein. During the procedure, blood reflux was observed when the needle tip was not within the ultrasound field of view. We did not try to find the tip; however, a guide wire and a central venous catheter were inserted without any resistance. Subsequently, when inducing blood reflux from the distal port of the central venous catheter, only clear fluid, suspected to be lymphatic fluid, was regurgitated. Further, chest X-ray revealed an appearance similar to that of the path of the thoracic duct. Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray, we suspected thoracic duct cannulation.

CONCLUSION

It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.

Keywords: Central venous catheter insertion; Left internal jugular vein; Thoracic duct; Lymph; Ultrasound; Case report

Core Tip: Central venous catheter insertion is an invasive procedure that requires detailed knowledge of the anatomy and attention of the proceduralist. It is recommended to use the right internal jugular vein for this procedure to avoid damaging the thoracic duct. However, regardless of right or left insertion, it is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.