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Hemodialysis catheter malfunction is one of the important complications of HD catheters. It may occur either early or late after catheter insertion. Although it is a common complication, the cause of catheter malfunction may be very fastidious to diagnose. This is due to the absence of a reliable three-dimensional imaging modality for HD catheters. Most Interventional Nephrology (IN) centers depend on fluoroscopic guidance in HD catheter insertion. However, C-arm machines are scarcely available in low-income countries; therefore, blind catheter insertion was adopted in many centers.
As a tertiary referral center, we have reported some cases of catheter malfunction that were not diagnosed without lateral chest x-ray.
We have reported 10 cases of HD catheter early malfunction that were inserted outside our facility. All patients had internal jugular tunneled HD catheters. Patients were referred to us after multiple trials of failed treatment. Eight cases showed normal PA x-rays and two cases showed improper tip position in the Superior Vena Cava vein. Lateral chest x-ray was ordered for each patient. We noticed 2 findings that could not be evaluated using the PA view.
The First Finding (Catheter tip position in the azygous vein): Patients with these catheters showed a catheter tip malposition in the PA view. Catheter tip seems to be in the superior vena cava in each patient. However, the lateral x-ray showed catheter kinked and maldirected to the azygous vein with catheter tip in the azygous vein. Most of these catheters where repositioned under c-arm guidance. (Figure 1)
1. We recommend doing a lateral x-ray view for patients with early catheter malfunction as a last step if routine investigations cannot be diagnostic.
2. Further studies are needed for this purpose.