SVC Duplication: The case of the erroneous catheter tip

In most individuals with normal anatomy, the SVC lies to the right of the heart and drains into the right atrium. SVC duplication is one of several possible explanations if a central venous catheter tip is found to the left of the heart. It is thought to occur in around 0.1% of the general population and in 10% of those with congenital heart disease. It is a mostly benign condition. Our case involved a 73-year-old lady who was admitted to our critical care department for vasopressor support following an acetabular ORIF. Her left internal jugular vein was cannulated with a 16cm quad-lumen CVC using an USS-guided, seldinger technique. A routine post-insertion chest x-ray demonstrated the line to follow a course to the left ofthe cardiac shadow with the tip along the left margin. Due to the unusual location and the uncertainty as to whether this line was safe to use, the case was discussed with the on-call radiologist who recommended a CT thorax to confirm the line position. This scan showed SVC duplication, with the CVC tip lying within a left-sided SVC terminating in the heart (likely the left-atrium). There was no dextrocardia or situs invertus. Whilst rare, this case highlights the importance of chest imaging following CVC insertion. In terms of the safety in using such a catheter, that should be determined by the drugs being infused, the possible locations and abnormalities presented by such a position and whether there are any other suspected complications as a result of insertion. This should be determined on a case-by-case basis. Keywords: SVC duplication, central venous catheter position, central line.