“A continuous infusion of alprostadil was planned. Since peripheral venous access was difficult, a 4.5 F triple-lumen central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) under ultrasound guidance. Intravenous fluid and alprostadil infusion were commenced after confirmation of correct placement by free aspiration of the blood from all three ports and with chest X-ray. Due to poor response to alprostadil infusion, the child was posted for balloon atrial septostomy under general anesthesia. After septostomy, the SpO2 improved to 88% on room air, and the child was extubated. Two days later, the child was posted for arterial switch operation (ASO). In the operation room, there was the absence of free aspiration of venous blood from the distal port of CVC. After anesthesia induction and endotracheal intubation, ultrasound imaging of the right IJV revealed the presence of thrombus with CVC in situ [Figure 1]. A TTE examination was prompted to look for any extension of thrombus into cardiac chamber. The latter disclosed the absence of thrombus in the right atrium [Figure 2]. Due to possible risk of systemic embolization associated with CVC removal, it was left in situ and another CVC was inserted into the right femoral vein.”

Chennakeshavallu GN, Sankar S, Ponnaboyina S. Incidental Intraoperative Detection of Central Venous Catheter-related Internal Jugular Vein Thrombus in an Infant with d-Transposition of Great Arteries. J Med Ultrasound. 2021 Apr 23;29(4):296-297. doi: 10.4103/JMU.JMU_128_20. PMID: 35127414; PMCID: PMC8772474.