Peripherally Inserted Central Catheter-Induced Right Atrium Thrombosis and Superior Vena Cava Dissection

2017 ◽  
Vol 22 (1) ◽  
pp. 20-21
Author(s):  
Priyank Shah ◽  
Rahul Vasudev ◽  
Raja Pullatt ◽  
Fayez Shamoon
Keyword(s):  
Pulmonary Embolism ◽  
Superior Vena Cava ◽  
Rare Complication ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Access ◽  
Right Atrial ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Picc Line

Abstract A 42-year-old woman with past medical history of intravenous drug abuse was admitted to hospital with fever and heart murmur. A peripherally inserted central catheter (PICC) was inserted because the patient had poor venous access. Transesophageal echocardiography was done to rule out infective endocarditis. The test showed thrombus attached to the PICC line. Thrombus arising from a catheter is known complication of PICCs. Classifications of right heart thromboembolism (RHTE) are based on morphology. Type A thrombi are highly mobile and may prolapse through the tricuspid valve. Conversely, type B thrombi are attached to the right atrial or ventricular wall and may originate in association with foreign bodies or in structurally abnormal chambers. RHTEs are associated with pulmonary embolism in approximately 4%–6% of cases and increase the 3-month mortality rate from 16% to 29%. On echocardiography, partial dissection of the superior vena cava (SVC) was also noted. This is a very rare complication of PICC. To the best of our knowledge this is the first reported case of PICC-induced thrombosis with partial dissection of SVC. The PICC line was removed and echocardiography postremoval did not show any thrombus. The patient remained asymptomatic without any signs of hemodynamically significant pulmonary embolism. SVC dissection was also managed conservatively. Use of central venous catheters in clinical practice is increasing but it is not a benign procedure. It may be associated with serious complications.

scholarly journals Persistent Left Superior Vena Cava Identified during Peripherally Inserted Central Catheter Line Placement

2019 ◽  
Vol 5 (02) ◽  
pp. 64-66
Author(s):  
Arvind Borde ◽  
Vivek Ukirde
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Left Superior Vena Cava ◽  
Anatomical Variant ◽  
Persistent Left Superior Vena ◽  
Line Placement ◽  
Picc Line

Abstract Introduction A persistent left superior vena cava (SVC) is found in 0.3 to 0.5% of the general population. It is seen in up to 10% of the patients with a congenital cardiac anomaly, being the most common thoracic venous anomaly, and is usually asymptomatic. Being familiar with such anomaly could help clinicians avoid complications during the placement of central lines, Swan-Ganz catheters, peripherally inserted central catheter (PICC) lines, dialysis catheters, defibrillators, and pacemakers. Case Presentation We describe a case of persistent left SVC which was noted after placement of a PICC line. A 5-year-old male child was hospitalized for evaluation and management of leukemia. He required PICC line placement for chemotherapy. He was noted to have a persistent left SVC during the procedure under fluoroscopic guidance and subsequently correct placement of PICC line in right SVC. Discussion This anatomical variant can pose iatrogenic risks if the clinician does not recognize it. A central catheter that tracks down the left mediastinal border may also be in the descending aorta, internal thoracic vein, superior intercostal vein, pericardiophrenic vein, pleura, pericardium, or mediastinum. Conclusion Our case is significant because the patient was diagnosed with double SVC on table only followed by the placement of PICC line into the right SVC. This case strongly demonstrates the importance of knowing the thoracic venous anomalies.

Persistent Left Superior Vena Cava

2014 ◽  
Vol 19 (2) ◽  
pp. 84-85 ◽  
Author(s):  
Vicki L. Mabry ◽  
Anne T. Mancino ◽  
Sheila Cox Sullivan
Keyword(s):  
Superior Vena Cava ◽  
Chest Radiograph ◽  
Incidental Finding ◽  
Superior Vena ◽  
Vena Cava ◽  
Vascular Anomaly ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena

Abstract This is a case report of an incidental diagnosis of persistent left superior vena cava (PLSVC). The diagnosis was suspected after a peripherally inserted central catheter (PICC) was placed and a postinsertion chest radiograph was conducted. PLSVC is a vascular anomaly that is usually diagnosed as an incidental finding. Here, we discuss the tests performed to confirm the diagnosis and the 3 variants of PLSVC. Nurses who place PICCs are likely to run across this abnormality on postinsertion chest radiograph and knowing the diagnostic test to order to confirm the diagnosis is key in expediting patient care.

Repositioning of malpositioned peripherally inserted central catheter lines with the use of intracavitary electrocardiogram: A pediatric case series

2019 ◽  
Vol 21 (2) ◽  
pp. 259-264 ◽  
Author(s):  
Mark D Weber ◽  
Adam S Himebauch ◽  
Thomas Conlon
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Right Atrial ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Case Presentation ◽  
Central Lines ◽  
Catheter Tip ◽  
Standard Radiographs

Introduction: Peripherally inserted central catheter tip migration is an infrequent event that occurs in neonatal, pediatric, and adult patients. We discuss a novel technique of utilizing intracavitary electrocardiogram to help confirm proper peripherally inserted central catheter tip repositioning, thereby reducing the need for serial radiographs. Case presentation: A case series of four patients will be discussed. The first three patients had peripherally inserted central catheter tips that were initially appropriately positioned but had later peripherally inserted central catheter tip migration. The use of intracavitary electrocardiogram was able to confirm the appropriate repositioning of the peripherally inserted central catheters without the need for serial radiographs. The fourth patient had several central lines in place, which led to difficulty in identifying the peripherally inserted central catheter tip location. The use of intracavitary electrocardiogram confirmed proper positioning of his peripherally inserted central catheter tip when standard radiographs could not provide clarity. Discussion: Several techniques have been published on methods to reposition a migrated peripherally inserted central catheter tip back to the superior vena cava/right atrial junction. These repositioning techniques often require fluoroscopic guidance or a confirmatory radiograph to assess the appropriate peripherally inserted central catheter tip location. At times, several radiographs may be required before the tip is successfully repositioned. This novel application of intracavitary electrocardiogram can help to minimize radiographs when peripherally inserted central catheter tip repositioning is required.

The Use of CT Imaging Technology in Peripherally Inserted Central Catheter

2021 ◽  
Vol 11 (1) ◽  
pp. 114-119
Author(s):  
Ying Wu ◽  
Guohua Huang ◽  
Qiufeng Li ◽  
Jinai He
Keyword(s):  
Superior Vena Cava ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Ct Imaging ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Imaging Technology ◽  
X Ray ◽  
The Right

Objective: The objective is to explore the application of computed X-ray tomography (CT) imaging technology in peripherally inserted central catheter (PICC), and to propose a more effective method for PICC catheterization. Method: In this study, 69 subjects are divided into the observation group (X-ray and CT) and the control group (X-ray). The guiding effect of CT images on PICC tube placement in complex cases is compared. In this study, CT localization of the superior vena cava–caval-atrial junction (CAJ) is used as the gold standard. The position relationship of carina-CAJ and carina-PICC catheter tip is measured and analyzed by CT image and chest radiography (CXR) image, providing scientific basis for PICC tip imaging. Results: After this study, the tip of the catheter should be 1/3 of the middle and lower part of the superior vena cava, about 3 cm above the junction of the right atrium and the superior vena cava, and in the upper part of the diaphragm of the inferior vena cava, so that it cannot enter the right ventricle or the right atrium. The best position of the tip of the catheter is near the junction of the superior vena cava and the right atrium. The average vertical distance between the tracheal carina and CAJ is 4.79 cm. Conclusion: CT and X-ray examination can effectively determine the location of the tip of PICC catheter in cancer chemotherapy patients, but the clarity of X-ray examination is missing. It is suggested to adopt CT examination, and further adopt and promote it.

Modified Insertion of a Peripherally Inserted Central Catheter: Taking the Chest Radiograph Earlier

2011 ◽  
Vol 31 (2) ◽  
pp. 64-69 ◽  
Author(s):  
Geng Tian ◽  
Bin Chen ◽  
Li Qi ◽  
Yan Zhu
Keyword(s):  
Infection Rate ◽  
Superior Vena Cava ◽  
Chest Radiograph ◽  
Superior Vena ◽  
Vena Cava ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Catheter Tip

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).

scholarly journals The use of laser lead extraction sheath in the presence of supra-cardiac occlusion of the central veins for cardiac implantable electronic device lead upgrade or revision

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251829
Author(s):  
Sameer Al-Maisary ◽  
Gabriele Romano ◽  
Matthias Karck ◽  
Raffaele De Simone ◽  
Jamila Kremer
Keyword(s):  
Superior Vena Cava ◽  
Complication Rate ◽  
Electronic Device ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Access ◽  
Left Ventricular ◽  
Right Atrial ◽  
Lead Extraction ◽  
Severe Stenosis

Background The implantation of cardiac implantable electronic devices (CIED) has increased in the last decades with improvement in the quality of life of patients with cardiac rhythm disorders. The presence of bilateral subclavian, innominate or superior vena cava obstruction is a major limitation to device revision and/or upgrade. Methods and material This is retrospective study of patients who underwent laser-assisted lead extraction (LLE) (GlideLight laser sheath, Spectranetics Corporation, Colorado Springs, USA) with lead revision or upgrade using the laser sheath as a guide rail. Patients with known occlusion, severe stenosis or functional obstruction of the venous access vessels with indwelling leads were included in this study. Results 106 patients underwent percutaneous LLE with lead revision and/or upgrade. Preoperative known complete occlusion or severe stenosis of access veins was present in 23 patients (21.5%). More patients with implantable cardioverter-defibrillator (ICD) underwent LLE (64.1%) than patients with CRT-Ds (24.5%) and pacemaker patients (11.3%). In total 172 leads were extracted: 79 (45.9%) single-coil defibrillator leads, 35 (20.3%) dual-coil defibrillator leads, 31 (18.0%) right atrial leads, 24 (13.9%) right ventricular leads and three (1.7%) malfunctional coronary sinus left ventricular pacing leads. The mean age of leads was 99.2±65.6 months. The implantation of new leads after crossing the venous stenosis/obstruction was successful in 98 (92.4%) cases. Postoperative complications were pocket hematoma in two cases and wound infection in one case. No peri-operative and no immediate postoperative death was recorded. One intraoperative superior vena cava tear was treated by immediate thoracotomy and surgical repair. Conclusion In a single-center study on LLE in the presence of supra-cardiac occlusion of the central veins for CIED lead upgrade and revision we could demonstrate a low procedural complication rate with no procedural deaths. Most of the leads could be completely extracted to revise or upgrade the system. Our study showed a low complication rate, with acceptable mortality rates.

Paradoxical Electrocardiographic Rhythm During Peripherally Inserted Central Catheter Insertion from Persistent Left Superior Vena Cava

2017 ◽  
Vol 22 (1) ◽  
pp. 15-18
Author(s):  
Nicholas Mifflin ◽  
Vanno Sou ◽  
Evan Alexandrou ◽  
Antony Stewart ◽  
Jules Catt
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Gas Analysis ◽  
Arterial System ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Left Vena

Abstract Introduction: A persistent left superior vena cava is one of the most common thoracic vascular anomalies, present in approximately 0.5% of the general population. The most common presentation is both a right and left superior vena cava, communicating through an innominate vein. In rare cases, complete absence of a right sided superior vena cava may have dispersion of pacemaker and conduction tissue leading to abnormal electrocardiography readings. Case Description: This case report describes the insertion of a peripherally inserted central catheter via the right basilic vein utilising ultrasound and electrocardiographic guidance during which atypical P-waves were noted. Post procedure chest x-ray found the catheter to be positioned to the left side of the chest. Discussion and Evaluation: Initial management was to assess whether the catheter was placed in the arterial system. Catheter transduction and blood gas analysis demonstrated the peripherally inserted central catheter was situated in the venous system. Computer tomography was then used to assess the patient's vasculature, demonstrating a persistent left vena cava with absence of a right vena cava. Conclusion: This case describes the successful placement of a right basilic peripherally inserted central catheter in a patient with a persistent left vena cava with an absent right superior vena cave using ultrasound and electrocardiographic guidance.

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

2008 ◽  
Vol 13 (4) ◽  
pp. 179-186 ◽  
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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