Two recent PICC insertions on patients with left-sided SVCs has created quite the controversy on my IV/PICC team.
About 50% of us feel that correct placement of the PICC tip in a patient with a confirmed left SVC is at the level of the carina or "mid SVC" to ensure the tip is not entering or overwhelming the coronary sinus.
The other half of the team feels there is no policy on this and/or literature and if the radiologist feels the tip location is ok, then it's ok.
I am searching for any journal articles that address correct tip location for left-sided SVC CVC placement. Specifically how deep the catheter can be, and instruction on recognizing if the tip is, in fact, in the coronary sinus.
Any thoughts?
Here is a sampling of the articles in my database but not sure if they will address your specific question:
1. Arat N, Sokmen Y, Golbasi Z. Persistent left superior vena cava with absent right superior vena cava and coronary sinus dilation mimicking a paracardiac mass. Tex Heart Inst J. 2007;34(4):492-493.
2. Azocar R, Narang P, Talmor D, Lisbon A, Kaynar A. Persistent left superior vena cava identified after cannulation of the right subclavian vein. Anesthesia and Analgesia. 2002;95:305-307.
3. Greenberg M, Raggio C. Antecubital central venous catheter placement complicated by a persistent left superior vena cava. Journal of Neurosurgical Anesthesiology. 2000;12(2):114-117.
4. Imran N, Grubb B, Kanjwal Y. Persistent left superior vena cava: a blessing in disguise. Europace. May 2008;10(5):588-590.
5. Josloff R, Kukora J. Central venous catheterization via persistent left superior vena cava. The American Surgeon. 1995;61(9):781-783.
6. Kamola PA, Seidner DL. Peripherally inserted central catheter malposition in a persistent left superior vena cava. J Infus Nurs. May-Jun 2004;27(3):181-184.
7. Kao CL, Chang JP. Malposition of a catheter in the persistent left superior vena cava. A rare complication of totally implantable venous devices. J Cardiovasc Surg (Torino). Feb 2003;44(1):145-147.
8. Korkeila P, Nyman K, Ylitalo A, et al. Venous obstruction after pacemaker implantation. Pacing Clin Electrophysiol. Feb 2007;30(2):199-206.
9. Miraldi F, di Gioia CR, Proietti P, De Santis M, d'Amati G, Gallo P. Cardinal vein isomerism: an embryological hypothesis to explain a persistent left superior vena cava draining into the roof of the left atrium in the absence of coronary sinus and atrial septal defect. Cardiovasc Pathol. May-Jun 2002;11(3):149-152.
10. Oginosawa Y, Abe H, Nakashima Y. Prevalence of venous anatomic variants and occlusion among patients undergoing implantation of transvenous leads. Pacing Clin Electrophysiol. May 2005;28(5):425-428.
11. Pautler S, Muirhead N. Soft-tissue images. Persistent left superior vena cava. Canadian Journal of Medicine. 1999;42(1):7.
12. Schummer W, Schummer C. Images in cardiovascular medicine. Cannulation of a persistent left superior vena cava: a clue given by ECG guidance. Circulation. Sep 19 2006;114(12):e503-504.
13. Shyamkumar NK, Brown R. Double superior vena cava with a persistent left superior vena cava: an incidental finding during peripherally inserted central catheter placement. Australas Radiol. Dec 2007;51 Suppl:B257-259.
14. Ying ZQ, Ma J, Xu G, Chen MY. Double superior vena cava with a persistent left superior vena cava. Intern Med. 2008;47(7):679-680.
You can also access this old short Q&A column I wrote many years ago for JVAD at
http://www.hadawayassociates.com/articles/article19.pdf
The INS SOP addresses catheter malposition including Left PSVC, but does not answer your specific question. I am the one who assessed the literature on this standard and did not find anything more than this problem exists. Good luck with your search.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
O.K. I may be showin my ignorance on this. Is there a condition/diagnosis called "left superior vena cava", or are you just rerferring to someone who has had a PICC line placed in the left arm?
After seeing the title of the articles Lynn attatched I am thinking this is something I am totally unfamilar with.
Thanks, Gina Ward R.N., CPAN
Gina Ward R.N., VA-BC
This is a recognized malformation of the SVC called a persistent left SVC. It can easily be confused with arterial placement. Many adults do not even know they have this until they need something like a CVAD. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861