An ECG method for positioning the tip of a PICC in "mirror people" with dextrocardia: A case report

Intracavitary electrocardiogram (ECG) has been widely used for PICC tip positioning in patients with a normal left heart. However, there is little information about using ECG for PICC insertion in patients with mirror dextrocardia. We report a 70-year-old stomach cancer patient with mirror dextrocardia admitted to our vascular access center for four Fr silicon Groshong PICC insertion. We successfully performed an ultrasound-guided modified Seldinger technique for insertion. First, the usual standardized ECG technique was used for tip positioning, and it failed. Then, we changed the procedure slightly, using the opposite electrode connections (RA: the first intercostal space of the midline of the left clavicle; LA: the first intercostal space of the midline of the right clavicle; and LL: the inferior margin of the right costal arch) to obtain an evident P-wave change to guide catheter placement in this case. We confirm that we can use the opposite electrodes to obtain an apparent P-wave for locating the catheter tip in patients with mirror dextrocardia.