Malpositioned PICC in IVC

Case contributed by Daniel J Bell
Diagnosis certain


ICU patient. Check PICC position.

Patient Data

Age: 80 years
Gender: Female

Right-sided PICC insertion with the tip projected over the expected position of the inferior cavoatrial junction/IVC. NGT normally sited. Surgical staples in the mid upper abdomen. Left basal pleural effusion

Case Discussion

PICC are commonly inserted catheters when long-term intravenous access is needed. They are inserted on critical care units, as well as in the outpatient setting, e.g. for cancer chemotherapy. The optimal positioning is at the approximate superior cavoatrial junction. In this case the PICC crosses the right atrium, and lies at the inferior cavoatrial junction/IVC. A transcardiac/intracardiac position of the catheter increases the risk of arrhythmias.

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