Abstract
A 67-year-old male with a history of end-stage kidney disease requiring in-center hemodialysis (HD) three days a week via left brachiocephalic graft presented with altered mental status. The hospital course was complicated by graft thrombosis. As the patient could not undergo thrombectomy immediately, he underwent temporary HD catheter using ultrasound-guided right internal jugular vein (IJV) cannulation. Post-procedure chest X-ray to confirm this access indicated that this central venous catheter (CVC) was misplaced, with its tip placed into the right axillary vein. This access was not used for HD, and he eventually underwent thrombectomy of the graft and angioplasty of the graft stenosis. The patient later underwent tunneled HD catheter placement under fluoroscopy at the time of thrombectomy, which revealed a torturous superior vena cava, which may indicate why the temporary HD catheter entered the subclavian vein, eventually with its tip at the right axillary vein. This report highlights the crucial importance of radiological confirmation of any CVC placement, especially HD catheters. HD should not be performed until the location of the dialysis catheter has been verified.