Spontaneous correction of misplaced peripherally inserted central catheters

  • Wenfeng Chen
  • Lianxiang He
  • Liqing Yue
  • Mijung ParkEmail author
  • Haoyu DengEmail author
Original Paper


The purpose of the present study was to examine a new protocol involving the spontaneous correction of the misplaced tip of a peripherally inserted central catheter (PICC). Patients with PICCs misplaced in the jugular or contralateral subclavian veins were recruited. All patients underwent chest X-ray (CXR) after 3 days. In addition, those whose PICC tip still was misplaced and received another CXR after 4 days. The functions of the catheters, the subjective feelings of the patients, and local symptoms of the neck and upper anterior chest wall were recorded. Among 866 patients who had PICCs, we observed 22 PICC tips misplaced in the jugular, 3 tips misplaced in the contralateral subclavian vein, and 7 tips misplaced in other locations, which was confirmed by CXR. A total of 22 PICC tips automatically returned to the superior vena cava, which included all 3 tips in the contralateral subclavian vein and 19 tips in the jugular vein. All catheters functioned normally, and the patients had no complaints. In addition, we observed no local symptoms of the neck and upper anterior chest wall. For patients experiencing a PICC misplaced in the jugular and contralateral subclavian veins, there is no need to manually replace. In addition, the function of the catheter can remain normal.


Peripherally inserted central catheters (PICC) Tip malposition Internal jugular Contralateral subclavian vein 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. Informed consent: Informed consent was obtained from all individual participants included in the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Johansson E, Hammarskjöld F, Lundberg D, Arnlind MH (2013) Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: a systematic review of the literature. Acta Oncol 52(5):886CrossRefPubMedGoogle Scholar
  2. 2.
    Merrell SW, Peatross BG, Grossman MD, Sullivan JJ, Harker WG (1994) Peripherally inserted central venous catheters. Low-risk alternatives for ongoing venous access. West J Med 160(1):25PubMedPubMedCentralGoogle Scholar
  3. 3.
    Kumar M, Amin M (2004) The peripherally inserted central venous catheter; friend or foe? Int J Oral Maxillofac Surg 33(2):201–204CrossRefPubMedGoogle Scholar
  4. 4.
    Bidgood C (2016) Improving the patient experience with real-time PICC placement confirmation. Br J Nurs 25(10):539CrossRefPubMedGoogle Scholar
  5. 5.
    Dale M, Higgins A, Carolanrees G (2016) Sherlock 3CG® tip confirmation system for placement of peripherally inserted central catheters: A NICE medical technology guidance. Appl Health Econ Health Policy 14(1):41–49CrossRefPubMedGoogle Scholar
  6. 6.
    Jin JF, Zhao RY, Shentu YQ (2012) The effect of clinical practice in manual reduction on patients with malposition of PICC. Chin J Nurs 47:160–161Google Scholar
  7. 7.
    Yuan L, Lu QM, Wang CL, Xu RF (2014) Application of breathing coordination in reducing catheter tip malposition during PICC inserting. Chin J Nurs 49:498–502Google Scholar
  8. 8.
    Jeon EY, Koh SH, Lee IJ, Ha HI, Park BJ (2015) Useful equation for proper estimate of left side peripherally inserted central venous catheter length in relation to the height. J Vasc Access 16(1):42–46CrossRefPubMedGoogle Scholar
  9. 9.
    Qian HU, Song M, Xue-Yu LI, Liu HY, Zheng ZD, Xie XD, Zhou LJ (2013) Comparison on the effect of three different methods on preventing PICC ectopic in jugular veins. Chin J Nurs 178(s 1–4):241–255Google Scholar
  10. 10.
    Lelkes V, Kumar A, Shukla PA, Contractor S, Rutan T (2013) Analysis of the Sherlock II tip location system for inserting peripherally inserted central venous catheters. Clin Imaging 37(5):917CrossRefPubMedGoogle Scholar
  11. 11.
    Wei S, Wang A, Zhao S (2011) Discussion of PICC ectopic adjustment method. Chin J Nurs Train 26:1620–1622Google Scholar
  12. 12.
    Kay C, Alicia D, Renee OM (2016) Complications & interventions. In: Josie S (ed) Study guide for vascular access certification, 2nd edn. Association for Vascular Access, Herriman, pp 30–48Google Scholar
  13. 13.
    Lisa G, Lynn H, Mary H, Mary M, Marsha O, Darcy D (2016) Central vascular access device (CVAD) malposition. In: Alexander M (ed) Infusion therapy standards of practice, 1st edn. Infusion Nurses Society, Norwood, pp 79–87Google Scholar
  14. 14.
    Song L, Hui LI (2013) Malposition of peripherally inserted central catheter: experience from 3,012 patients with cancer. Exp Ther Med 6(4):891–893CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Song LP, Li XS, Guo YY, Ye M, Ma YL, Guo M et al (2014) Malposition of peripherally inserted central catheter: experience from 3012 cancer patients. Int J Nurs Pract 20(4):446CrossRefPubMedGoogle Scholar
  16. 16.
    Minkovich L, Djaiani G, Mccluskey SA, Mitsakakis N, Gilbert RW, Beattie WS (2011) Frequent malpositions of peripherally inserted central venous catheters in patients undergoing head and neck surgery. Can J Anaesth 58(8):709–713CrossRefPubMedGoogle Scholar
  17. 17.
    Geng T, Yan Z, Li Q, Guo F, Xu H (2010) Efficacy of multifaceted interventions in reducing complications of peripherally inserted central catheter in adult oncology patients. Support Care Cancer 18(10):1293–1298CrossRefGoogle Scholar
  18. 18.
    Cunningham RS, Ravikumar TS (1995) A review of peripherally inserted central venous catheters in oncology patients. Surg Oncol Clin N Am 4(3):429PubMedCrossRefGoogle Scholar
  19. 19.
    Aladangady N, Roy R, Costeloe KL (2005) The cobweb sign: percutaneous silastic long line tip placement in tributaries of superficial veins. J Perinatol 25(10):671–673CrossRefPubMedGoogle Scholar
  20. 20.
    Mitrović Z et al (2014) The use of peripherally inserted central catheter (PICC) in patients with hematological malignancies—a single center experience. Lijec Vjesn 136(6):136–140PubMedGoogle Scholar
  21. 21.
    Chen WF, Deng HY, Shen LF, Qin M, He LX (2014) A comprehensive intervention program on the long-term placement of peripherally inserted central venous catheters. J Cancer Res Ther 10:359–362CrossRefPubMedGoogle Scholar
  22. 22.
    Wu PY, Yeh YC, Huang CH, Lau HP, Yeh HM (2005) Spontaneous migration of a port-a-cath catheter into ipsilateral jugular vein in two patients with severe cough. Ann Vasc Surg 19(5):734–736CrossRefPubMedGoogle Scholar
  23. 23.
    Prabaharan B, Thomas S (2014) Spontaneous migration of central venous catheter tip following extubation. Saud J Anaesth 8(1):131CrossRefGoogle Scholar
  24. 24.
    Sweeney R (1998) Spontaneous correction of the malpositioned percutaneous central venous line in infants. Pediatr Radiol 28(9):694CrossRefGoogle Scholar
  25. 25.
    Kundra P, Chandran BVS, Subbarao KSVK. (2009) Unanticipated complication of a malpositioned central venous catheter. J Anesth 23(2):275–277CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Oncology Department, Xiangya HospitalCentral South UniversityChangshaChina
  2. 2.Nursing Department, Xiangya HospitalCentral South UniversityChangshaChina
  3. 3.Department of Family Health Care NursingUCSF School of NursingSan FranciscoUSA
  4. 4.Nuclear department, Xiangya HospitalCentral South UniversityChangshaChina

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