IC-ECG guided PICC tip location in a dextrocardia: A case report

Area of Science:

• Medical Imaging and Diagnostics
• Cardiology
• Interventional Radiology

Background:

• Peripherally inserted central catheters (PICCs) are crucial for long-term venous access.
• Patients with congenital conditions like situs inversus totalis present unique challenges for central venous access device placement.
• Intracavitary electrocardiography (IC-ECG) is a valuable tool for guiding PICC tip localization.

Purpose of the Study:

• To report a successful peripherally inserted central catheter (PICC) placement using intracavitary electrocardiography (IC-ECG) guidance in a patient with situs inversus totalis and dextrocardia.
• To illustrate the application of the column of saline technique for real-time PICC tip positioning in complex anatomy.
• To contribute clinical data for understanding PICC placement in mirror-image patients.

Main Methods:

• A 59-year-old male with esophageal cancer and situs inversus totalis underwent PICC insertion.
• Intracavitary electrocardiography (IC-ECG) was utilized to guide the peripherally inserted central catheter (PICC) tip to the cavo-atrial junction (CAJ).
• The column of saline technique was employed to monitor P-wave changes for real-time tip position estimation.

Main Results:

• The patient had dextrocardia and situs inversus totalis, with organs mirrored.
• PICC insertion was successfully completed without any reported adverse events.
• The IC-ECG guidance and column of saline technique allowed for precise localization of the catheter tip.

Conclusions:

• IC-ECG guided PICC placement is feasible and effective even in patients with complex congenital anomalies like situs inversus totalis.
• Accurate tip positioning is critical and can be achieved using IC-ECG monitoring in challenging anatomies.
• This case highlights the importance of adapting established techniques for specialized patient populations and contributes to the body of knowledge for PICC insertion in mirror-image patients.