Wandering peripherally inserted central catheter tip: an under-recognised intensivist challenge.

A 75-year-old man with a history of atrial fibrillation presented with altered mental status. He was intubated in the emergency department for airway protection. A CT scan of the brain revealed multiple embolic strokes. He also developed aspiration pneumonia after 48 h in the intensive care unit. In view of poor peripheral intravenous access and stable haemodynamics, a peripherally inserted central catheter (PICC) was placed using the microintroducer technique from the right side via the basilic vein. The position of PICC tip was found at the junction of the superior vena cava (SVC) and the right atrium and was confirmed with a standard technique of real-time ECG monitoring during insertion and chest X-ray (CXR) postinsertion (figure 1A). A …