Endothelial thrombus formation: an unusual complication related to peripherally inserted central catheters

The Nutritional Support Service (NSS) at William Beaumont Hospital has successfully inserted over 2000 peripherally inserted central catheters (PICCs) since the inception of its PICC program in 1990. The following is a case study of a 43-year-old female with diabetes mellitus and multiple drug allergies who presented to the NSS after Wound Clinic personnel were unable to pull a 43 cm PICC more than 38 cm out of her left arm. Radiographic studies showed the remaining 5 cm of the catheter to be untangled, following the course of the cephalic vein. A surgical cutdown was performed to dilate the cephalic vein and remove the device. The PICC tip was encapsulated in an organic material which was confirmed by pathology to be a thrombus with endothelial lining.