Incidental persistent left superior vena cava

"However, what happens when a wire is presumed to be in the vein after confirming it on ultrasound, only to see the catheter not take the correct course? Congenital vascular anomalies exist, but how often do we encounter them in the emergency department, and how do we address this during fast-paced procedures" Kelesis et al (2025).

"However, what happens when a wire is presumed to be in the vein after confirming it on ultrasound, only to see the catheter not take the correct course? Congenital vascular anomalies exist, but how often do we encounter them in the emergency department, and how do we address this during fast-paced procedures" Kelesis et al (2025).

ReTweet

Incidental persistent left superior vena cava

Extract:

“Emergency physicians have an arsenal of procedures at their disposal to stabilize the unstable patient. It is common for physicians to perform these procedures quickly to avoid complete decompensation of the patient. Among these procedures, central venous catheter (CVC) placement is often used. CVC insertion is indicated in cases of vasoactive or phlebosclerotic medication administration, difficult or inadequate peripheral intravenous access, or when patients are undergoing mass transfusion, hemodialysis, and other catheter insertions, including transvenous pacing and Swan Ganz (1). These catheters can be placed in multiple large vessels, including the internal jugular, femoral, and subclavian veins. There are a multitude of methods that physicians employ when inserting CVCs, such as anatomic landmarks or ultrasound guidance. Currently, the American Society of Anesthesiologists recommends real-time ultrasound-guided CVC placement (2). CVCs are almost entirely placed via the Seldinger or modified Seldinger technique, in which a guide wire is threaded into the vein and the catheter is placed over it (2,3). Different practitioners use various techniques to confirm wire placement in the vein prior to dilatation. Most emergency physicians use ultrasound and trace the wire running through the large vein. Others use real-time manometry, which requires utilization of a peripheral intravenous catheter. Practitioners may choose to puncture the vein with the peripheral intravenous catheter or thread the catheter over the wire to then use the tubing and test real-time manometry. However, what happens when a wire is presumed to be in the vein after confirming it on ultrasound, only to see the catheter not take the correct course? Congenital vascular anomalies exist, but how often do we encounter them in the emergency department, and how do we address this during fast-paced procedures?”

Reference:

Kelesis M, Deadmond M, Nix K. Incidental Persistent Left Superior Vena Cava and Other Anatomic Anomalies During Emergent Central Line Placement in the Emergency Department: A Case Report. J Emerg Med. 2025 Aug 21;78:37-40. doi: 10.1016/j.jemermed.2025.08.027. Epub ahead of print. PMID: 40945395.