Placement of a Peripherally Inserted Central Catheter Line in a Persistent Left Superior Vena Cava: A Review of Positioning and Clinical Implications

Background: Persistent left superior vena cava (PLSVC) occurs in approximately 1 in every 200 people, and with various malformations. Nurses who insert peripherally inserted central catheters (PICCs) may need to place a PICC line in this venous malformation. Aims: To review the literature and assess the safety of positioning a PICC line in a PLSVC, and to also assess the ideal placement of a PICC line in a PLSVC with reference to a chest radiograph and intravenous electrocardiogram (IVECG) navigation. Methodology: Literature search across 5 main databases, alongside hand-searched articles. Results: No literature was found that prohibits placement of a PICC line in a PLSVC, unless the PLSVC enters the left atrium, and no literature was found that identifies an ideal position for the PICC tip in a PLSVC. Two approximate positions were highlighted: high in the PLSVC or passed through a bridging brachiocephalic vein to a right superior vena cava. Placing a PICC line in a PLSVC using IVECG navigation is shown to produce abnormal electrocardiogram readings. Conclusions: A PICC line can be safely placed in a PLSVC as long as the PLSVC does not enter the left atrium, avoiding potential systemic embolization. Final positioning of the PICC tip on a chest radiograph is proposed to be in the midregion between the carina and the junction of the PLSVC/coronary sinus, with the aim of avoiding coronary sinus thrombosis and providing satisfactory dilution of infusate. If abnormal electrocardiogram readings during IVECG placement are seen, then PLSVC should be suspected. Further research and data are needed due to limited research in this area.