Uncommon Malposition of an Ultrasound-Guided Central Venous Catheter in the Renal Vein through the Superficial Femoral Vein: A Case Report

Ting-Chia Remus Young^1,2, Kuang-Hua Cheng^1,3, Kuan-Pen Yu^1,4

1 Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
2 Department of Medicine, Mackay Medical College, New Taipei, Taiwan
3 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan
4 Department of Anesthesiology, MacKay Memorial Hospital, Taipei, Taiwan

DOI: 10.2478/jccm-2024-0026

Introduction: Malposition is a relatively rare complication associated with peripherally inserted central catheters (PICCs), particularly in cases of superficial femoral vein (SFV) catheterization. To the best of our knowledge, we are the first to report this rare case of SFV PICC malposition in the contralateral renal vein.
Case presentation: An 82-year-old woman underwent bedside cannulation of the SFV for PICC under ultrasound guidance. Subsequent radiographic examination revealed an unexpected misplacement, with the catheter tip positioned toward the contralateral renal vein. After pulling out the catheter on the basis of the X-ray result, it was observed that the catheter retained its function.
Conclusion: Although rare, tip misplacement should be considered in SFV PICC placement. Prompt correction of the tip position is crucial to prevent catheter malfunction and further catastrophic consequences. For critical patients receiving bedside SFV PICC insertion, postoperational X-ray is crucial for enhancing safety.