What does this research mean for the field?

Left internal jugular central venous catheters can rarely malposition into the left superior intercostal vein, underscoring the importance of confirmatory imaging when left-sided access is utilized. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To report a rare case of left internal jugular central venous catheter malposition into the left superior intercostal vein.

May 20, 2026

C52-32 A Rare Malposition of a Left Internal Jugular Central Venous Catheter Into the Left Superior Intercostal Vein

Key Points

To report a rare case of left internal jugular central venous catheter malposition into the left superior intercostal vein.
Described a case of a 79-year-old woman undergoing open right hemicolectomy with left IJ central venous cannulation.
Utilized ultrasound guidance for catheter placement and confirmatory imaging with computed tomography.
Post-procedural assessment included chest radiography and blood gas analysis.
Catheter tip was confirmed to be in the LSICV via computed tomography without significant complications.
Patient underwent surgery uneventfully with subsequent catheter removal without issues.
Malposition rates noted were significantly higher for left IJ access compared to right IJ access.

Abstract

Abstract IntrodCuction Central venous catheter (CVC) placement is a routine procedure in perioperative and critical care practice. Malposition occurs in approximately 5-12% of internal jugular (IJ) cannulations and is more frequent with left IJ access compared to the right, given the longer and more angulated course into the superior vena cava (SVC). While azygos and brachiocephalic malpositions are recognized, inadvertent cannulation of the left superior intercostal vein (LSICV) is exceedingly rare. Case Report A 79-year-old woman was admitted for open right hemicolectomy with extensive adhesiolysis and repair of a small bowel enterotomy. Due to poor peripheral access, central venous cannulation was pursued. The right IJ was deemed less suitable because of its narrow caliber and close proximity to the carotid artery. A triple-lumen catheter was placed via the left IJ under ultrasound guidance without immediate complications. Post-procedural chest radiograph demonstrated the catheter tip overlying the aortic shadow, concerning for malposition. A bubble contrast study was inconclusive; however, venous placement was supported by blood gas analysis (pH 7.38, pCO2 44 mmHg, pO2 30 mmHg). Computed tomography of the chest confirmed malposition into the LSICV, without mediastinal hematoma or pneumothorax. The patient proceeded with surgery uneventfully, and the catheter was later removed without complication. Discussion The LSICV, a tributary of the accessory hemiazygos system draining the second to fourth intercostal spaces into the left brachiocephalic vein, may become prominent in elderly patients or in those with pulmonary hypertension, elevated right atrial pressures, or venous obstruction. Malposition of CVCs is more common via the left IJ (8-12%) compared with the right IJ (2-3%), owing to the anatomical course of the left brachiocephalic vein. Potential complications include thrombosis, vascular injury, and failure to achieve adequate central access. This case highlights the importance of recognizing venous variants, favoring right IJ cannulation when feasible, and employing confirmatory imaging when left IJ access is required. This abstract is funded by: None

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C52-32 A Rare Malposition of a Left Internal Jugular Central Venous Catheter Into the Left Superior Intercostal Vein

Key Points

Abstract

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