Advertisment Polium-B
Indian Journal of Critical Care Medicine
An open access publication of ISCCM™ 
 
Users online: 1358 
     Home | Login 
  About Current Issue Archive Search Instructions Online Submission Subscribe Etcetera Contact  
  NAVIGATE Here 
  Search
 
  
 RESOURCE Links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (396 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free) 

  IN THIS Article
   References
   Article Figures

 Article Access Statistics
    Viewed930    
    Printed26    
    Emailed0    
    PDF Downloaded195    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
LETTER TO THE EDITOR
Year : 2013  |  Volume : 17  |  Issue : 4  |  Page : 262-263

What is normal in an abnormality? Central venous cannulation in a patient with Situs inversus totalis with dextrocardia and polyCystic kidney disease


Department of Anaesthesiology, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, India

Date of Web Publication19-Sep-2013

Correspondence Address:
Vinodhadevi Vijayakumar
Department of Anaesthesiology, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-5229.118406

Rights and Permissions




How to cite this article:
Vijayakumar V, Kandappan G, Udayakumar P, Padmanabhan R. What is normal in an abnormality? Central venous cannulation in a patient with Situs inversus totalis with dextrocardia and polyCystic kidney disease. Indian J Crit Care Med 2013;17:262-3

How to cite this URL:
Vijayakumar V, Kandappan G, Udayakumar P, Padmanabhan R. What is normal in an abnormality? Central venous cannulation in a patient with Situs inversus totalis with dextrocardia and polyCystic kidney disease. Indian J Crit Care Med [serial online] 2013 [cited 2018 May 27];17:262-3. Available from: http://www.ijccm.org/text.asp?2013/17/4/262/118406


Sir,

Situs inversus totalis (SIT) with dextrocardia and poly cystic kidney disease (PCKD) is a rare condition, which can be associated with total anomalous pulmonary venous connection (TAPVC) and persistent right-superior vena cava (SVC). [1],[2] Central venous catheterization (CVC) in patients with anatomical abnormalities are complex and challenging, especially in emergency situations.

Our patient was a 38-year-old lady diagnosed with SIT coupled with dextrocardia and PCKD, who underwent ureteroscopic lithotripsy under spinal anesthesia. Postoperatively, she developed urosepsis, hemodynamic instability, requiring CVC. Although preoperative echocardiography had revealed dextrocardia, normal cardiac chambers, right aortic arch, and left SVC, relative position of internal jugular vein (IJV) and carotid artery in the neck was doubtful. Because of unavailability of ultrasonography during emergent cannulation, right subclavian vein (A) was cannulated and correct positioning confirmed with pressure waveform. Post CVC chest X-ray [Figure 1] revealed the CVC crossing the midline through the right-brachiocephalic vein (B) entering the left SVC (C) toward the morphologic right atrium. In normal patients, correctly positioned right CVC remains on the right side without crossing the midline. If it crosses the midline, it could be because of the malposition into the left internal jugular, left subclavian vein, or left persistent SVC. There are few exceptions for the correctly positioned right CVC to cross the midline, and SIT is one of them. [3]
Figure 1: What is normal in an abnormality? Central venous cannulation in a patient with situs inversus totalis with dextrocardia and poly cystic kidney disease

Click here to view


In patients with SIT, if right CVC has not crossed the midline and below the level of carina, its entry into persistent right SVC, TAPVC, and malposition into the aorta should be suspected.

In our patient, we later confirmed using ultrasound the normal great vessel relationship in the neck. In SIT, the relationship of carotid artery and internal jugular veins remains normal. Such anatomical relationships are as equally important during CVC as during the cardiothoracic surgery. Preferable site of CVC in a patient with SIT would be left IJV, as it has a straighter course using ultrasonography.

 
  References Top

1.Jayakrishnan MP, Devarajan E. Situs inversus with autosomal recessive polycystic kidney disease. Indian Pediatr 2008;45:701-2.  Back to cited text no. 1
[PUBMED]    
2.Neema PK, Duara R, Manikandan S, Rathod RC. Total anomalous pulmonary venous connection in a patient with situs inversus and dextrocardia: Which internal jugular vein to cannulate, right or left? J Cardiothorac Vasc Anesth 2006;20:632-3.  Back to cited text no. 2
[PUBMED]    
3.Umesh G, Ranjan S, Jasvinder K, Nanda S. Carina as a useful and reliable radiological landmark for detection of accidental arterial placement of central venous catheters. J Clin Monit Comput 2010;24:403-6.  Back to cited text no. 3
[PUBMED]    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
Online since 7th April '04
Published by Wolters Kluwer - Medknow