Peripherally inserted central catheters (PICCs) are widely indicated for therapies, but malposition into accessory veins, such as the azygos vein, can lead to serious complications including thrombosis or vascular perforation. In most published cases, misplacement is detected only postoperatively, delaying essential treatment and increasing morbidity. Intracavitary ECG (IC-ECG) and transthoracic echocardiography (TTE) with the bubble test are accurate, immediate, real-time intraoperative methods for tip location that avoid radiation. This report details a clinical case where the simultaneous application of IC-ECG and TTE enabled the early intraoperative identification and correction of inadvertent azygos vein cannulation during PICC insertion.
Asti et al. (Sun,) studied this question.