After confirming venous blood (ABG through PICC/IJ/SUB) we have left in place with no known complications. Your x-ray post catheter placement was the only reason it was found! I have also heard of others having IR do dye study or venagram to further document.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
There is a documented case in the literature supporting this. The authors placed a PICC, positioned in the LSVC, in a patient who received his "6-week course of antibiotics without incident."
Daphne Broadhurst,RNOttawa, ON
Persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the superior vena cava system. Left superior vena cava exists in early embryonic development, but this vessel degenerates as the cardiovascular system matures. Failure of this process to occur results in PLSVC. If not associated with other cardiac malformations, PLSVC has no clinical signs or symptoms. This article discusses a case of PLSVC diagnosed after placement of two peripherally inserted central venous catheters that appeared to malposition outside the central circulation. After unsuccessful bedside placement of the two catheters, the patient was referred to interventional radiology for placement of a Hickman catheter. A contrast injection study showed the presence of a PLSVC with the absence of a normal right superior vena cava. The tip of the peripherally inserted central venous catheter was found to be at a satisfactory location within the PLSVC.
Kamola, Patricia A. RN; Seidner, Douglas L. MD, FACG Peripherally Inserted Central Catheter Malposition in a Persistent Left Superior Vena Cava. Journal of Infusion Nursing. 27(3):181-184, May/June 2004.
Daphne BroadhurstDesjardins PharmacyOttawa, Canada