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Table 1 Stepwise approach to differentiate true venous placement from inadvertent arterial cannulation following dialysis catheter insertion

From: Hemodialysis catheter insertion: is increased PO2 a sign of arterial cannulation? A case report

1- Do not remove the catheter
2- Attach a pressure transducer to the catheter and discriminate between venous and arterial waveforms*
3- Perform blood gas analysis (high PO2 is suggestive of arterial blood)**
4- Obtain Chest X-ray (frontal and lateral)
5- If still in doubt, obtain Computed Tomography Angiography***
6- Surgical or endovascular intervention if arterial cannulation is confirmed
  1. *not effective if severe hypotension, atrial fibrillation, constrictive pericarditis or severe pulmonary hypertension with tricuspid regurgitation.
  2. **not effective in rare cases of anomalous vascular anatomy.
  3. ***if intravenous iodinated contrast not contraindicated.