PICC for Monday, September 30th, 2024

Contributed by Childrens Hospital Vanderbilt
Chris Barron MD, and Neil Johnson MD.

History

PICC (Peripherally Inserted Central Catheter) placed via left upper limb. Radiology Chest X-Ray report says "PICC tip in Right Jugular Vein". You are not sure that is correct!

Images (Click any image to enlarge)

Question

Do you agree with the radiology report? If not - Where do you think the PICC tip is?

Your answer

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Correct answer

This patient is on full arterio - venous ECMO (Extra Corporeal Membrane Oxygenation).

The PICC tip has been "vacuumed" up into the Superior Vena Cava (SVC) Venous blood retrieval catheter

Discussion

ECMO is a life saving technology pioneered by Dr Robert Bartlett in the 1980's. It is a form of cardio - pulmonary bypass.

Two Basic types:

  1. Arterio - Venous ECMO
  2. Veno - Venous ECMO

This patient was being treated with Arterio - Venous ECMO. The Venous catheter is in the Superior Vena Cava / right atrium and deoxygenated blood is being aspirated for membrane oxygenation in the ECMO circuit.  The PICC was inadvertently "sucked up into the ECMO venous catheter"

Differential diagnosis

Left Upper Limb PICC within ECMO Venous cannula

Additional images

References

  • https://en.wikipedia.org/wiki/Robert_Bartlett_(surgeon)
  • https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation
  • https://medlineplus.gov/ency/article/007234.htm