Bedside insertion of a peripherally inserted central catheter into a patient with BMI of 84.8 kg/m2 using a magnetic tracking and electrocardiogram-based tip confirmation system: a case report

Abstract

BackgroundPeripherally inserted central catheters (PICCs) are typically placed under fluoroscopy. We used a magnetic tracking and electrocardiogram-based tip confirmation system for insertion of a PICC insertion in a morbidly obese patient at the bedside.Case presentationA 53-year-old female with severe obesity (height, 160 cm; weight, 217 kg; BMI, 84.8 kg/m2) was admitted to the intensive care unit. Both bilateral, inguinal, and cervical regions were covered with an excess of adipose tissue, making it difficult to place a central venous line. Since transferring her to fluoroscopy seemed dangerous, a PICC was inserted using Sherlock 3CG® TCS at the bedside. Magnetic sensor guidance failed due to the thick subcutaneous tissue her precordium, but intracavity electrocardiography could direct the tip to an appropriate position.ConclusionWe experienced bedside insertion of a PICC into a patient with BMI of 84.8 kg/m2 patient using a Sherlock 3CG® TCS. Since the interaction between Sherlock 3CG® TCS and body habitus has not been investigated, further reports are needed.