Unusual malposition of a peripherally inserted central catheter into the left pericardiophrenic vein: A case report

2021 ◽  
pp. 112972982110189
Author(s):  
Alfonso Piano ◽  
Annamaria Carnicelli ◽  
Emanuele Gilardi ◽  
Nicola Bonadia ◽  
Kidane Wolde Sellasie ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Superior Vena ◽  
Vena Cava ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
X Ray ◽  
Bubble Test ◽  
Chest X Ray ◽  
The Right ◽  
Pericardiophrenic Vein

We report a case of primary malposition of a PICC inserted by guidewire replacement in the emergency room. Intraprocedural tip location by intracavitary electrocardiography was not feasible because the patient had atrial fibrillation; intraprocedural tip location by ultrasound (using the so-called “bubble test”) showed that the tip was not in the superior vena cava or in the right atrium. A post-procedural chest X-ray confirmed the malposition but could not precise the location of the tip. A CT scan (scheduled for other purposes) finally visualized the tip in a very unusual location, the left pericardiophrenic vein.

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.

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.

scholarly journals Ultrasonography Versus Chest X-Ray to Confirm Proper Placement of Central Venous Catheter

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Mehrnaz Nikouyeh ◽  
Kiandokht Khorshidi ◽  
Mohammad Hassan Rouzegari ◽  
Rabee Sarram
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Underlying Disease ◽  
Central Venous ◽  
X Ray ◽  
Comparison Results ◽  
Chest X Ray ◽  
The Right

Background: Central venous catheter (CVC) is located within the proximal third of the superior vena cava, inferior vena cava, or the right atrium. The confirmation of right location of catheter’s tip is done by chest X-ray (CXR) routinely. Objectives: In this study, we compared the proper location of the tip of the catheter by ultrasonography with CXR. Patients and Methods: One hundred and seventeen patients were included in this study. The CVC was placed according to the underlying disease. The proper location of the catheter was checked by ultrasonography and then CXR was carried out. The results of both methods were recorded and finally the statistical analysis was performed for comparison. Results: The tip of the catheter was observed by ultrasonography in 111 patients, but in the six other ones, the tip of the catheter was not observed by ultrasonography and observed in CXR. Therefore, the sensitivity of ultrasonography was 94.9 % in this study. Conclusion: The results showed that ultrasonography shows the catheter in 94.9% of the cases, although the risk of exposure to X-ray does not exist. The cost and time for evaluation of the tip of the catheter is significantly less by using ultrasonography compared to CXR.

scholarly journals Isolated Persistent Left Superior Vena Cava Revealed by an Associated Asthma

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
I. Bachouch ◽  
N. Belloumi ◽  
M. Attia ◽  
F. Chermiti Ben Abdallah ◽  
S. Hantous Zannad ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Corticosteroid Treatment ◽  
Inhaled Corticosteroid ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
X Ray ◽  
Chest X Ray ◽  
The Right

Background. Persistent left superior vena cava (PLSVC) is a rare anomaly of the thoracic venous system. Case Report. We present a case of a patient with isolated asymptomatic PLSVC, who was diagnosed because of dyspnea revealing an associated asthma. An 18-year-old male patient complained of paroxystic sibilant dyspnea. He did not have any anomaly in physical examination. The chest X-ray revealed cardiomegaly with a widening of lower mediastinum. The electrocardiogram does not show any anomaly. Echocardiography showed the PLSVC. The thoracic contrast computed tomography of the chest showed ecstasies of the right cardiac cavities and a double superior vena cava. The patient did not have similar family cases. Respiratory functional explorations led to the diagnosis of an associated asthma. Currently, he is followed up periodically. Asthma was improved with inhaled corticosteroid treatment. Conclusion. PLSVC is rare but can have important clinical implications. Associated severe cardiac malformations must be systematically sought.

scholarly journals Aplasia of the superior vena cava and persistent superior left vena cava in a 3-year-old child: Case report

2021 ◽  
Vol 11 (1) ◽  
pp. 85-90
Author(s):  
Vladimir V. Lazarev ◽  
Tatiana V. Linkova ◽  
Pavel M. Negoda ◽  
Anastasiya Yu. Shutkova ◽  
Sergey V. Gorelikov ◽  
...  
Keyword(s):  
Case Report ◽  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Vascular Access ◽  
Vascular System ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
X Ray ◽  
The Right

BACKGROUND: Structural features of the patients vascular system can cause unintended complications when providing vascular access and can disorient the specialist in assessing the location of the installed catheter. This study aimed to demonstrate anatomical features of the vascular system of the superior vena cava and diagnostic steps when providing vascular access in a child. CASE REPORT: Patient K (3 years old) was on planned maintenance of long-term venous access. Preliminary ultrasound examination of the superior vena cava did not reveal any abnormalities. Function of the right internal jugular vein under ultrasound control was performed without technical difficulties; a J-formed guidewire was inserted into the vessel lumen. X-ray control revealed its projection in the left heart, which was regarded as a technical complication, so the conductor was removed. A further attempt to insert a catheter through the right subclavian vein led to the same result. For a more accurate diagnosis, the child underwent computed angiography of the superior vena cava system. Congenital anomalies of the vascular system included aplasia of the superior vena cava and persistent left superior vena cava. Considering the information obtained, the Broviac catheter was implanted under ultrasound control through the left internal jugular vein without technical difficulties with the installation of the distal end of the catheter into the left brachiocephalic vein under X-ray control. CONCLUSION: A thorough multifaceted study of the vascular anatomy helps solve the anatomical issues by ensuring vascular access and preventing the risks of complications.

Idiopathic Atrial Fibrillation and Coronary Arteriovenous Fistulae: Is There a Link?

Cardiology ◽  
2016 ◽  
Vol 134 (4) ◽  
pp. 433-435 ◽  
Author(s):  
Hina K. Jamali ◽  
Umara Raza ◽  
Fahad Waqar
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrhythmias ◽  
Similar Case ◽  
Superior Vena ◽  
Vena Cava ◽  
Definitive Treatment ◽  
Arteriovenous Fistulae ◽  
Coronary Arteriovenous Fistula ◽  
The Right ◽  
New Onset

Despite being one of the most prevalent cardiac arrhythmias, the cause of atrial fibrillation (AF) in a vast majority of patients remains unknown. There is growing evidence of associated AF in patients diagnosed with coronary arteriovenous fistula. In this discussion, we have included an example of a patient who presented with new-onset AF and was subsequently diagnosed with an anomalous fistula between the right coronary artery and the superior vena cava. Definitive treatment of the fistula resulted in permanent resolution of the AF. Based on this case and a similar case reported in the literature, it is proposed that further research will unmask this possibly underdiagnosed and very treatable cause of AF.

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.

Electrocardiography-controlled central venous catheter tip positioning in patients with atrial fibrillation

2018 ◽  
Vol 19 (6) ◽  
pp. 528-534 ◽  
Author(s):  
Folkert Steinhagen ◽  
Maximilian Kanthak ◽  
Guido Kukuk ◽  
Christian Bode ◽  
Andreas Hoeft ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Central Venous Catheter ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
The Right

Introduction: A significant increase of the p-wave of a real-time intracavitary electrocardiography is a reliable and safe method to confirm the central venous catheter tip position close to the atrium. However, conflicting data about the feasibility of electrocardiography exist in patients with atrial fibrillation. Methods: An observational prospective case–control cohort study was set up to study the feasibility and accuracy of the electrocardiography-controlled central venous catheter tip placement in 13 patients with atrial fibrillation versus 10 patients with sinus rhythm scheduled for elective surgery. Each intervention was crosschecked with ultrasound-guided positioning via right supraclavicular fossa view and chest radiography. Ultrasound-guided supraclavicular venipuncture of the right subclavian vein and guidewire advancement were performed. A B-mode view of the superior vena cava and the right pulmonary artery was obtained to visualize the J-tip of the guidewire. The central venous catheter was advanced over the guidewire and the electrocardiography was derived from the J-tip of the guidewire protruding from the central venous catheter tip. Electrocardiography was read for increased p- and atrial fibrillation waves, respectively, and insertion depth was compared with the ultrasound method. Results: Electrocardiography indicated significantly increasing fibrillation and p-waves, respectively, in all patients and ultrasound-guided central venous catheter positioning confirmed a tip position within the lower third of the superior vena cava. Conclusion: Electrocardiography-guided central venous catheter tip positioning is a feasible real-time method for patients with atrial fibrillation. Combined with ultrasound, the electrocardiography-controlled central venous catheter placement may eliminate the need for postinterventional radiation exposure.

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.

Sign in / Sign up

Export Citation Format

Share Document