PICC insertion in the sitting position for a patient with congestive heart failure: A case report.

Mitsuda, Shingo; Tokumine, Joho; Matsuda, Rena; Yorozu, Tomoko; Asao, Takayuki

RATIONALE A peripherally inserted central catheter (PICC) is typically inserted with the patient in the supine position. Here, we placed a PICC in a patient in the sitting position, in order to treat congestive heart failure. PATIENT CONCERNS A 65-year-old man was diagnosed with end-stage lung cancer. He had experienced septic shock and was medicated with continuous infusion of noradrenaline through a peripheral vein, in order to maintain sufficient blood pressure. However, indwelling peripheral venous catheters were difficult to place and maintain. DIAGNOSIS The patient experienced orthopnea due to congestive heart failure and could not assume any other position. INTERVENTIONS An anesthesiologist performed PICC placement while the patient was in the sitting position, using ultrasound guidance. OUTCOMES The patient's orthopnea was slightly ameliorated, and he was able to sleep at night. LESSONS The technique of inserting a PICC in the sitting position is simple and feasible. This approach may be useful for patients in whom central venous access is needed, but the supine position cannot be achieved.