• Jung A Lim, Chan Hee Jee, and Kyung-Hwa Kwak.
• Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
• Medicine (Baltimore). 2017 Jun 1; 96 (24): e7187e7187.

RationaleThe misplacement of central venous catheter (CVC) can occur more often at the left jugular vein than the right side due to anatomic differences. And many of the previously reported cases are about catheter misplacement resulting from vessel penetration associated with guidewire. This case differs that the catheter itself through the sheath introducer can cause venous injury that may lead to the malposition of CVC particularly through an approach to the left internal jugular vein.Patient Concerns, Diagnosis, Interventions, And OutcomesWe cannulated a large-bore CVC with a sheath introducer, namely mult-lumen access catheter (MAC) in the left jugular vein of patient under anesthesia using ultrasound and inserted the additional central venous oximetry catheter through the sheath introducer of MAC and confirmed aspiration of blood. However, the postoperative imaging study revealed malposition of the tip of the oximetry catheter in the mediastinum.Main LessonThe insertion of additional catheter through the sheath introducer needs to be carried out as carefully as the insertion of guidewire and should be confirmed with imaging study after the procedure.

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