Correct!
4. 1 and 3

The device appears to be functioning correctly but the chest x-ray appearance is concerning for possible arterial placement. To ensure that the device is not in the arterial circulation, aspirate blood from the device and obtain a blood gas from this sample and a simultaneous ABG. Another method is to connect a pressure transducer to check for arterial or venous waveform. These can be done quickly at the bedside and save an unnecessary escalation of care. If these tests suggest arterial cannulation if arterial is still suspected, the device should NOT be removed as brisk bleeding could occur into the mediastinum.

A pressure tracing was consistent with venous pressure and blood aspirated was consistent with a venous sample. A thoracic CT scan was ordered because of the unusual appearance of the pacer (Figure 2).

Figure 2. Video images from thoracic CT scan in soft tissue windows in axial (upper left), coronal (upper right middle) and sagittal (lower) views.

Which of the following are false about the condition? (Click on the correct answer to proceed to the fourth of five panels)

1. A normal right SVC is not commonly found in this anomaly
2. Most patients present because they are symptomatic from a right left intra-cardiac shunt
3. The anomalous drainage is most commonly into the coronary sinus
4. This is the most common congenital abnormality of the venous system in the chest
5. All are false

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