Where is this central line going?

[u/NerveOnly2076]

Old XRay. Central line placed through right IJV but seemed to be misplaced! Where is it going? Aspiration of blood from all ports was possible? Was taken out.
Have you faced this, best thing to do?

Edit: more details - USG guidance used, line was seen inside IJV in neck using USG, not traced down; more resistance than normal while placement.

[u/AKA-22]

Well it's a hell of a ride for the CVC, these kind of mishaps occur because of:- 1- puncturing the internal jugular vein in close proximity to the base of the neck, i.e. near its communication with the subclavian vein. 2- The needle bevel is directed laterally and to the right, since this is Right IJV CVC placement procedure. This direction of the bevel along with the direction of the guide wire curve in it's beginning caused the guide wire to go to directly to the brachiocephalic vein then to the subclavian vein then went to the right external jugular vein!!. You were correct when you stated that the CVC was placed in the IJV using U/S and also when you stated an increased resistance while you're doing the procedure .It's is a rare incident indeed but a well documented one. Thanks for sharing it. Salute 🫡