Hemodialysis catheter malpositioned into the mediastinum: Lessons from two cases.

Hemodialysis catheter (HDC) using a tunneled cuffed catheter (TCC) is a viable option for acute hemodialysis. Vessel injury during catheter insertion can lead to malpositioning of the HDC into the mediastinum. We herewith present two malpositioned HDCs in various clinical settings. For the first case, the HDC was inserted without fluoroscopic guidance, but in the second case, the HDC was inserted under fluoroscopic guidance. Our first case involved HDC insertion via the right internal jugular vein (IJV), and the second case involved HDC insertion via the left IJV. We clinically suspected HDC malposition because of poor aspiration, despite good infusion via the two lumens. Chest radiography, computed tomography, and venography showed various abnormal positions of the HDC. Our case report provides additional information about malpositioned or malfunctioning HDCs in various clinical settings.