Secondary migration of a pre-existing central venous catheter due to a Swan-Ganz catheter insertion

Background: The entanglement of multiple central venous catheters is a rare and serious complication. The Swan-Ganz catheter is a responsible for various cases. Case: A 66-year-old male patient was under general anesthesia for a coronary artery bypass graft surgery. As he had a pre-existing Perm catheter in the right subclavian vein, a Swan-Ganz catheter was inserted into the left internal jugular vein. Chest radiograph after catheter placement revealed that the Perm catheter had migrated to the left brachiocephalic vein. The surgeon attempted to reposition it manually, but postoperative radiograph showed that it had rolled into a loop. On postoperative day 1, radiological intervention was performed to untangle the loop, which was successful. Conclusions: After placing a Swan-Ganz catheter in patients with a pre-existing central ve-nous catheter, the presence of entanglement should be assessed. In such cases, radiolo-gy-guided correction is recommended, as a blind attempt to disentangle can aggravate the condition.