Malpositioned permacath

Case contributed by Henry Knipe

Presentation

Peripheral T cell lymphoma (PCTL) for autologous stem cell transplantation.

Patient Data

Age: 60 years
Gender: Female
x_ray

The proximal permacath tip is malpositioned in the right internal jugular vein. 

Post manipulation in fluoroscopy

x_ray

Permacath tips project in the SVC in an appropriate position for use. 

Case Discussion

Despite appropriate positioning at the cavo-atrial junction on supine fluoroscopy, the tip has migrated superiorly as demonstrated on the post-procedure erect chest x-ray. This often occurs in females with large breasts that migrate inferiorly when going from lying to sitting.

Fortunately in this case the permacath could be advanced under fluoroscopy so the tips are in an appropriate position both supine and erect projections. 

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