Superior Vena Cava Port Catheter Tip Confirmation: Quantified Formula for Intravascular Catheter Length versus Anatomic Landmark Reference

Placement of the tip of a peripherally inserted central catheter in the lower third of the superior vena cava is essential to minimize the risk of complications. Sometimes, however, the catheter tip cannot be localized clearly on the chest radiograph, and repositioning a catheter at bedside is difficult, sometimes impossible. A chest radiograph obtained just after the catheter is inserted, before the guidewire is removed, can be helpful. With the guidewire in the catheter, the catheter and its tip can be seen clearly on the radiograph. If the catheter was inserted via the wrong route or the tip is not at the appropriate location, the catheter can be repositioned easily with the guidewire in it. Between January 1, 2007, and May 31, 2009, 225 catheters were placed by using this method in our department. Of these, 33 tips (14.7%) were initially malpositioned. The tips of all these catheters were repositioned in the lower third of the superior vena cava by using this method. No catheter was exchanged or removed. The infection rate for catheter placement did not increase when this method was used. This modification facilitates accurate location of the catheter tip on the chest radiograph, making it easy to correct any malposition (by withdrawing, advancing, or even reinserting the catheter after withdrawal).

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Persistent Left Superior Vena Cava: A Finding After Central Venous Catheterization

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002161 ◽

2021 ◽

Author(s):

Francisco Lopes Morgado ◽

Bárbara Saraiva ◽

Celestina Blanco Torres ◽

João Correia

Keyword(s):

Superior Vena Cava ◽

Central Venous Catheterization ◽

Superior Vena ◽

Vena Cava ◽

Central Venous ◽

Left Superior Vena Cava ◽

Anatomical Variant ◽

Persistent Left Superior Vena ◽

Venous Catheterization ◽

Catheter Tip

Introduction: Persistence of the left superior vena cava (LSVC) is a rare anatomical variant in the general population with an estimated incidence of 0.3-0.5% in healthy individuals. Its diagnosis can be made incidentally after imaging control of central venous catheter (CVC) or other types of devices placements. Patient and Methods: We present the case of a patient with an acute disease which required central venous catheterization for the administration of intravenous chemotherapy. Results: Central venous catheterization proved difficult and after imaging control it revealed an unusual position of the catheter tip. Additional study to verify catheter tip position was performed and computed tomography (CT-scan) revealed the presence of a persistent left superior vena cava. The patient was then submitted to the planned treatment without any record of complications associated with CVC. Conclusion: Although uncommon the persistence of the LSVC can have an important impact in clinical practice, particularly when more invasive procedures are required. Its recognition is relevant in order to minimize the potential complications inherent to these procedures.

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Dose Intraoperative Fluoroscopy Precisely Predict Catheter Tip Location via Superior Vena Cava Route?

Medicine ◽

10.1097/md.0000000000002199 ◽

2015 ◽

Vol 94 (49) ◽

pp. e2199 ◽

Cited By ~ 1

Author(s):

Ching-Yang Wu ◽

Jui-Ying Fu ◽

Ching-Feng Wu ◽

Po-Jen Ko ◽

Yun-Hen Liu ◽

...

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Intraoperative Fluoroscopy ◽

Catheter Tip

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Cardiac Magnetic Resonance for Evaluating Catheter Related FDG Avidity

Case Reports in Radiology ◽

10.1155/2016/5460727 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Daniel Jeong ◽

Kenneth L. Gage ◽

Claudia G. Berman ◽

Jaime L. Montilla-Soler

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Superior Vena ◽

Vena Cava ◽

Port Catheter ◽

Positron Emission ◽

Pet Ct ◽

Catheter Tip ◽

History Of ◽

Fdg Avidity

A 53-year-old female with a history of metastatic left arm melanoma presented for F(18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) which showed a moderately FDG avid focus at her port catheter tip near the cavoatrial junction. Although catheter tip related FDG avidity has previously been suggested to be bland thrombus or infection, melanoma can metastasize to unusual locations including the superior vena cava. In addition, the patient had an elevated risk of anticoagulation due to a history of hemorrhagic brain metastases. Therefore, confirmatory cardiac magnetic resonance (CMR) was obtained and findings were consistent with bland catheter-related thrombus.

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The EKG Method for Positioning the Tips of PICCs: Results from Two Preliminary Studies

Journal of the Association for Vascular Access ◽

10.2309/java.13-4-4 ◽

2008 ◽

Vol 13 (4) ◽

pp. 179-186 ◽

Cited By ~ 35

Author(s):

Mauro Pittiruti ◽

Giancarlo Scoppettuolo ◽

Antonio La Greca ◽

Alessandro Emoli ◽

Alberto Brutti ◽

...

Keyword(s):

Cost Effectiveness ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

X Ray ◽

Non Invasive ◽

Catheter Tip

Abstract Two preliminary studies were conducted to determine feasibility of using the electrocardiography (EKG) method to determine terminal tip location when inserting a peripherally inserted central catheter (PICC). This method uses the guidewire inside the catheter (or a column of saline contained in the catheter) as an intracavitary electrode. The EKG monitor is then connected to the intracavitary electrode. The reading on the EKG monitor reflects the closeness of the intracavitary electrode (the catheter tip) to the superior vena cava (SVC). The studies revealed that the EKG method was extremely precise; all tips placed using the EKG method and confirmed using x-ray were located in the superior vena cava. In conclusion, the EKG method has clear advantages in terms of accuracy, cost-effectiveness, and feasibility in conditions where x-ray control may be difficult or expensive to obtain. The method is quite simple, easy to learn and to teach, non-invasive, easy to reproduce, safe, and apt to minimize malpositions due to failure of entering the SVC.

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A complication of subclavian port catheter: Superior vena cava syndrome

Journal of Contemporary Medicine ◽

10.16899/gopctd.283143 ◽

2016 ◽

Vol 6 (4) ◽

pp. 352-352

Author(s):

Yunus Oktay Atalay

Keyword(s):

Superior Vena Cava ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Vena Cava ◽

Port Catheter ◽

Vena Cava Syndrome

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Peripherally inserted central catheter malposition to a persistent left superior vena cava: A successful case to leave the catheter till the end of chemotherapy

The Journal of Vascular Access ◽

10.1177/1129729820938201 ◽

2020 ◽

pp. 112972982093820

Author(s):

Qi Li ◽

Yuxiu Liu ◽

Min Wang ◽

Zhongjie Yu ◽

Yufang Gao

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Catheter Insertion ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena ◽

Catheter Tip ◽

Tip Position

Persistent left superior vena cava is rare and asymptomatic and is usually discovered incidentally during or after insertion of a central venous catheter. There is uncertainty as to whether or not the catheter should be removed after its malposition resulting in persistent left superior vena cava. We reported an unusual case of a breast cancer patient with a persistent left superior vena cava detected after a peripherally inserted central catheter insertion. The patient had undergone a modified radical mastectomy and needed to insert a peripherally inserted central catheter for chemotherapy. After the peripherally inserted central catheter insertion, the chest X-ray and computed tomography showed that the catheter was located in the persistent left superior vena cava. After an assessment of the persistent left superior vena cava and the catheter tip position, the peripherally inserted central catheter remained in the persistent left superior vena cava for further therapy. To ensure the integrity of the catheter, special follow-ups and tip position observations were carried out. The peripherally inserted central catheter was safe until the end of chemotherapy with no complications. Although the peripherally inserted central catheter tip was located in persistent left superior vena cava, given that the persistent left superior vena cava coexisted with a right superior vena cava with the similar lumen, the peripherally inserted central catheter could be used normally under strict attention.

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Persistent left superior vena cava: a reason for pseudodisplacement of a port catheter

Surgical and Radiologic Anatomy ◽

10.1007/s00276-002-0088-4 ◽

2003 ◽

Vol 25 (1) ◽

pp. 70-72 ◽

Cited By ~ 3

Author(s):

L. Schiffmann ◽

M. Kruschewski ◽

F. Wacker ◽

H. J. Buhr

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Port Catheter ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena

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Catheterization of PICC through a superficial femoral vein for patients with superior vena cava syndrome using ECG positioning and ultrasound-guided technologies

The Journal of Vascular Access ◽

10.1177/11297298211035331 ◽

2021 ◽

pp. 112972982110353

Author(s):

Weizhu Xiao ◽

Qiuju Lin ◽

Shuping Chen ◽

Shanshan Li ◽

Cuifen Lin ◽

...

Keyword(s):

Superior Vena Cava ◽

Superior Vena Cava Syndrome ◽

Guide Wire ◽

Superior Vena ◽

Femoral Vein ◽

Vena Cava ◽

Ultrasound Guided ◽

Superficial Femoral Vein ◽

Catheter Tip ◽

Vena Cava Syndrome

Objective: We herein demonstrate the efficacy of PICC placement through a superficial femoral vein in patients with superior vena cava syndrome using ultrasound guidance and electrocardiographic localization. The treatment of PICC disconnection was also discussed. Methods: The study enrolled 51 patients with superior vena cava syndrome. Ultrasound-guided technology and ECG positioning technology are employed to help these patients in catheterization. The puncture time, the number of punctures, and catheter tip position were recorded. The patient was followed up for at least 2 years. The complications and treatment during follow-up were recorded. Result: The average puncture time was 32.13 ± 3.91 min. A total of 49 patients were successfully punctured once, while 2 patients failed in the first puncture. The main reason for puncture failure is that the inability of a guide wire to pass through. After the nurse removed the needle and pressed the puncture point until no rebleeding occurred, the puncture above the original puncture point was successful. X-ray examination revealed that the catheter tip was located in the inferior vena cava, above the diaphragm, near the right atrium. The success rate of catheterization was 100%. The visual analog scale (VAS) score was (2.44 ± 0.73) at the time of puncture, which was tolerable during the operation, and the patient did not complain of obvious pain following the operation. One patient developed complications of broken tube half a year after the puncture. Interventional physicians utilized angiography to locate the broken catheter. Conclusion: It is safe and feasible to place PICC through a superficial femoral vein under ultrasound combined with ECG positioning technology in patients with superior vena cava syndrome.

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