Scenario 1. A 23 yr old patient with antepartum hemorrhage was taken to OT for Caesarean section. She had profuse bleeding on table but could be controlled following delivery of baby, with blood transfusion and colloids. The chest on auscultation revealed fine basal creps and she had persistent hypotension.A central venous catheter was introduced through the right internal jugular vein. Confirmation of placement done by aspiration for free flow and rapid infusion of fluids.But the free flow was not obseved at a catheter length of 14 cm or13 cm but free flow observed at 11 cm.The patient remained ventilated and was shifted to the icu and CXR was taken The tip of the catheter appeared to be in the right subclavian vein with a slight angulation. A repeat procedure was deferred as the patient had coagulopathy and that the clinical confirmatory tests are satisfactory. The next day afternoon patient was complaining of raspiratory distress with tachypnea and pain on right side of chest. Auscultation revealed absent breath sounds on right side with dullness on percussion. A repeat CXR showed displacement of catheter tip, with massive pleural effusion on the right side which was drained subsequently.
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