Knot formation of a pulmonary artery catheter associated with right internal jugular vein thrombosis: a case report

Introduction: Pulmonary artery catheters (PACs) are an important hemodynamic monitoring tool; however, they are associated with various complications. We report a rare case of PAC entanglement with a central venous catheter (CVC) occurring in the internal jugular vein, due to right internal jugular vein thrombosis. Presentation of case: An 81-year-old woman underwent reoperation mitral valve replacement and left ventriculoplasty. During PAC insertion via the right internal jugular vein, resistance was encountered and the PAC was entangled with the CVC. The catheters were ultimately removed safely after CVC withdrawal. Discussion: It is presumed that the thrombus within the internal jugular vein was the cause of resistance and nodule formation. Careful ultrasound assessment and fluoroscopic guidance are essential when resistance occurs. Conclusion: PAC knotting in the internal jugular vein is extremely rare. Evaluation of venous thrombosis before reinsertion and cautious manipulation may prevent such complications.