Catheter Placement Research Articles

Cystoscopy and Transurethral Resection of Bladder Tumors with Stent and Foley Catheter Placement

Cystoscopy and Transurethral Resection of Bladder Tumors with Stent and Foley Catheter Placement

Prolonged intracranial catheter dwell time exacerbates penumbral stress and worsens stroke thrombectomy outcomes

BackgroundThe duration of mechanical thrombectomy (MT) is a negative predictor of outcomes in acute ischemic stroke (AIS), yet the precise mechanisms are unclear. We investigated whether the placement of large-bore...

Orexin concentrations and diurnal variation in the cerebrospinal fluid of intensive care unit patients undergoing aortic surgery with spinal drainage.

Cerebrospinal fluid (CSF) levels of orexin show a cyclic diurnal variation in healthy subjects, which is diminished in patients with certain diseases. However, possible circadian variations in orexin levels in critically ill patients remain unknown. In this study, we evaluated the orexin concentrations in the CSF and their diurnal variation in patients undergoing thoracic aortic aneurysm repair with lumbar intrathecal catheterization for CSF drainage after non-neurosurgery. Eligible patients with a lumbar intrathecal catheter placed for CSF drainage following aortic surgery at a single-center ICU between September 2019 and February 2020 were included. Catheters were placed before anesthesia induction, and CSF was collected at the time of catheter placement, ICU admission, and daily at 6:00, 12:00, 18:00, and 24:00 until the catheter was removed or for up to 5 days after admission to the ICU. Three patients (Patients A, B, and C) who underwent thoracic aortic aneurysm repair were included. Patients B and C received sedatives or hypnotics during the orexin measurement period. The baseline orexin levels for Patients A, B, and C were 219.9, 312.3, and 403.8 pg/mL, while the mean orexin levels were 319.4 ± 82.6, 372.4 ± 56.0, and 306.3 ± 48.3 pg/mL, respectively. For all three patients, orexin levels showed diurnal variations, but no consistent periodic changes. CSF orexin concentrations for patients undergoing thoracic aortic aneurysm repair in the ICU were within the reported range compared to those of previously reported healthy subjects; however, consistent periodic diurnal variations were not observed.

DDEL-06. CONVECTION-ENHANCED DELIVERY OF SEVEN DIFFERENT MOLECULES SHOW LARGE DIFFERENCES IN CONVECTIVE PROPERTIES BETWEEN MOLECULES. INFORMED DECISION MAKING FOR OPTIMIZED CATHETER PLACEMENT AND SUBSEQUENT INFUSION STRATEGIES

Abstract INTRODUCTION Glioblastoma (GBM) trials based on convection-enhanced drug delivery (CED) bypassing the blood-brain barrier have failed to prove efficient until now. Many factors influence CED. In this study we evaluated CED of seven different molecules using dynamic PET/MRI during infusion. This enabled in-depth evaluation of drug distribution and concentration gradients providing a more precise understanding of the Vd/Vi ratio and the extent of efficacy level across the Vd zone. Novel surgical catheter placement software algorithms, results in more informed-decision-making for catheter positioning and subsequent infusion planning strategies. METHODS Pigs were implanted with neuroinfuse™ drug delivery systems enabling intermittent drug infusions. Gadolinium, [124I]-UdR, [55Co]Co-DOTA-hEGF, [55Co]Co-DOTA-SP4, [18F]PSMA-1007 and three differently sized [64Cu]-labelled nanocarriers were evaluated in both pigs with and without a brain resection cavity. Gadolinium distribution was followed by MRI. PET imaging was used for the rest. To inform clinical trial design, strategic catheter placement and volumes to be infused, planning was investigated on several historical GBM cases. RESULTS Vd/Vi ratios ranged between 1.00 – 3.77. where large-sized liposomes performed best. Catheters stayed patent during weeks of repeated infusions. In the resected animals no leakage of drugs into the brain resection cavity was observed. Effective 3D modelling of novel catheter infusion planning aids provided visualized representations of tailor-made infusion plumes, capable of being suitably positioned to optimize surgical planning of catheters and transcutaneous reaccess port. CONCLUSION Large differences in convective properties between different molecules were observed. Large-sized liposomes as drug-carrier system showed superior performance to all other molecules. Vd/Vi ratios for promising drugs should be determined before initiating future clinical CED trials. Infusion concentration gradients to facilitate more precise Vd/Vi ratios provided important performance metrics for visualised infusion planning aids of a novel chronic drug delivery system, illustrating informed decision making for optimised catheter placement and subsequent infusion strategies is clinically translatable for GBM indications.

Factors associated with the use of regional anesthesia for calcaneal osteotomy in pediatric patients: A single-center, retrospective cohort study.

Despite known disparities in pediatric perioperative outcomes, few studies have examined factors associated with the use of regional anesthesia for pediatric orthopedic surgery. This investigation aimed to determine if minority and developmental disability status were associated with the allocation of peripheral nerve blocks in calcaneal osteotomy. We conducted a single-center, retrospective study of records of patients <18 years who underwent calcaneal osteotomy from 2013 to 2022. Regional technique was classified into three groups: popliteal-sciatic single-shot block, popliteal-sciatic catheter, and no block. Patients were classified as either nonminority (white, non-Hispanic) or minority. Developmental disability status was defined based on medical history and classified as binary. Anesthesiologists were classified as "regional" or "nonregional" based on clinical expertise. A Bayesian hierarchical multinomial model with random intercepts for patients and surgeons was used to investigate the association of minority status, developmental disability, and anesthesiologist expertise with block selection. We analyzed 287 cases in 225 patients; of these, 55% occurred in minority patients and 28% occurred in patients with developmental disability. Catheters were placed in 45% of cases, single shot blocks in 41%, and no block in 14%. Minority and nonminority patients had a similar likelihood of receiving of any block. Patients with developmental disability had a -22% absolute difference of receiving any block (95% credible interval [-38%, -7%]) compared to those without developmental disability (55% vs. 77%), an effect primarily driven by a lower rate of catheter placement in these children. Regional anesthesiologists were more likely to place catheters (23% absolute increase; 36% vs. 13%) and more likely to perform any block in children with developmental disability (30% absolute increase; 67% vs. 37%) than nonregional anesthesiologists. Decision-making surrounding the placement of regional anesthesia techniques is complex. In this study, developmental disability status and anesthesiologist experience were associated with a difference in the use of regional anesthesia in patients undergoing calcaneal osteotomy.

Bilateral Indwelling Pleural Catheter Placement for Advanced Non-small Cell Lung Cancer with Recurrent Pleural Effusion

Bilateral Indwelling Pleural Catheter Placement for Advanced Non-small Cell Lung Cancer with Recurrent Pleural Effusion

The impact of real-time ultrasound guidance on ventricular catheter placement in cerebrospinal fluid shunts - a single-center study.

Misplacement of ventricular catheters during shunt surgery occurs in 40% of cases using a freehand technique and therefore represents a risk for early shunt failure. The goal of this retrospective, single-center study is to analyze the impact of real-time ultrasound guidance on ventricular catheter positioning and early outcome of shunt survival. We analyzed the charts and images of all patients who underwent shunt surgery from 09/2017 to 12/2022 and compared the position of the ventricular catheter using the freehand technique and real-time ultrasound guidance. Central catheter position was graded as grade I (optimal), II (contact with ventricle structures or contralateral), and III (misplacement). A ventricular catheter was placed in 244 patients using real-time US guidance and in 506 patients using a freehand technique. The mean age (53.4 and 53.6 years, respectively) and the preoperative frontal occipital horn ratio (FOHR; 0.47 versus 0.44) were almost equal in both groups. In the study group, grade I catheter position was achieved in 64% of cases, grade II in 34%, and grade III in 2%. The control group showed grade I position in 45%, grade II in 32%, and grade III in 23% of cases (p<0.05). An early central catheter failure rate was the highest in grade III (40.5%) compared to 4% in grade I. Our data demonstrate that real-time US guidance leads to a significant improvement in ventricular catheter placement. Consequently, early shunt revisions decrease significantly. Further prospective, randomized, and controlled studies comparing the standard method to real-time ultrasound catheter placement are required.

No ureteral catheter mini percutaneous nephrolithotomy (NUC-mPCNL) achieves enhanced recovery after surgery (ERAS)

Conventional mini percutaneous nephrolithotomy (mPCNL) typically necessitates the pre-operative placement of ureteral catheters. With the development of enhanced recovery after surgery (ERAS), we introduce a novel approach: no ureteral catheter mini percutaneous nephrolithotomy (NUC-mPCNL). To evaluate the efficacy and safety of this innovative procedure compared to mPCNL, we compared the total operative time, stone clearance rate (SCR), stone-free rate (SFR), and complications among patients undergoing either modality from January to September 2021. Our findings revealed a statistically significant reduction in the mean total operative time for the NUC-mPCNL group (42.6 ± 2.4 vs. 60.2 ± 3.4 min, p < 0.001). The SCR, SFR and CSFR were comparable between two groups (98.5% vs. 97.8%, 84.3% vs. 76.0%, 64.7% vs. 60.0%, p = 0.337, 0.295, 0.625). WBC rise, hemoglobin drop and neutrophil percentage rise were similar in both groups. The overall complication rate in the NUC-mPCNL group was lower; however, the difference was not statistically significant (Clavien I, II and III; 11 vs. 13, 1 vs. 2 and 1 vs. 1). Consequently, we conclude that NUC-mPCNL effectively shortens the operative time and holds potential for expedited postoperative recovery.

How I do it: MRI-guided stereotactic navigation for Laser Interstitial Thermal Therapy.

MR-guided stereotaxy has emerged as a viable alternative to CT-guided frame-based or frameless approaches. By offering direct MR-guided navigation, this technique addresses most limitations inherent to CT navigation, enabling submillimeter precision. We detail the workflow of using the ClearPoint® MR navigation system for laser catheter placement in the treatment of a hypothalamic hamartoma. MR-guided navigation is a precise and effective stereotactic method for laser ablation of targets with high demands for accuracy. However, compared to standard stereotactic techniques, MR-guided navigation is more time-consuming and costly.

Post-procedural Brachial Neuritis: Clinical, Electrodiagnostic and Neuroimaging features.

Brachial neuritis is a monophasic condition affecting the brachial plexus and its branches, manifesting as acute shoulder and upper arm pain, followed by weakness and paresthesias. It can be triggered by antecedent events, including procedures such as surgery. Misdiagnosis and delay in diagnosis is common. Imaging is important to confirm the diagnosis of post-procedural brachial neuritis and exclude other etiologies. Clinical, electrodiagnostic, and neuroimaging features of patients with post-procedural brachial neuritis from a single quaternary care institution were identified and analyzed. Six (2 female) patients were identified with median age 62 (range 49-70) years. Antecedent procedures included 4 cervical spine surgeries, 1 rotator cuff repair, and 1 central venous catheter placement. Time to symptom onset ranged from 1-day to 2-weeks. The initial symptom for 5/6 patients was severe upper extremity pain followed by weakness. All patients had electrodiagnostic tests and MR neurography consistent with brachial neuritis. MR neurogram showed plexus and/or terminal branch abnormalities with associated muscular denervation edema. The C5 or C6 root, and/or upper trunk were always involved. The most common branches affected were the suprascapular, long thoracic, and axillary nerves. Hourglass constrictions of these nerves were seen in 3/6 patients. The average time to diagnosis was 3.4 (range 1.5-5) months. Post-procedural brachial neuritis is an underrecognized cause of acute upper extremity pain and weakness. MR neurography can exclude iatrogenic causes and document the presence of hourglass constrictions in affected nerves. Diagnostic neuroradiologists should be aware of this clinical entity and associated neuroimaging findings. HGC = hourglass constriction; EDX = electrodiagnostic; IRB = Institutional Review Board; ACDF = anterior cervical discectomy and fusion; NRS = Numerical Rating Scale; MUAP = motor unit action potential.

Intradetrusor OnabotulinumtoxinA outcomes for overactive bladder in older adults

Introduction:In older adults, pharmacological treatment of overactive bladder (OAB) with anticholinergics and beta-3 agonists could be associated with negative cognitive effects; highlighting the need for alternative treatment modalities. Currently, there is relatively little evidence assessing outcomes of onabotulinomtoxin-A injection as thirdline therapy in this population. This study sought to evaluate the outcomes of intradetrusor BTX-A injection in patients over 70 years of age between August 2014 March 2022. Methods:A retrospective chart review was performed on patients with a clinical diagnosis of OAB and who underwent an initial intradetrusor onabotulinomtoxinA injection at 70 years or older from three US centers. Patient characteristics and self-reported symptoms before and after injection were statistically analyzed. Results:Amongst the 210 patients, 94% reported urinary urgency, 92% reported urgency urinary incontinence, and 89% reported daytime frequency. The most common medications initially prescribed were beta-3 agonist at 66% and anticholinergics at 65%. Following treatment, 80% reported >50% improvement in incontinence, 81% in urgency, 79% in daytime frequency, and 78% in nocturia. Temporary de novo intermittent catheterization was initiated in 8/210 (3.8%) patients, and one (0.5%) required indwelling catheter placement; with 67% returning for repeat injections. Thirty-six (17%) had a symptomatic urinary tract infection at follow-up. Seventy-five percent of patients did not require drug therapy following injection. In a subgroup analysis of octogenarians (n = 50/210), 73% showed improvement in urgency and 68% had less incontinence post-injection. Discussion:OnabotulinomtoxinA was well tolerated in patients older than 70 with improvement in overactive bladder symptoms and reduction in requirement of drug therapy.

Misuse of External Urine Management Devices in Hospitalized Patients.

External urine management devices were introduced into healthcare as a novel solution to avoid indwelling urinary catheter placement and the associated urinary tract infection risk for adult patients. These devices are favored among healthcare workers and patients. However, the downstream impacts of this device can be detrimental to patient outcomes when immobility is promoted through their use. Clinical nurse specialists are the ideal team member to evaluate the introduction of new technology to promote patient-focused care over task-focused care.

Evaluation of short-term complications in laparoscopic peritoneal dialysis catheter placement - a single tertiary center experience

Evaluation of short-term complications in laparoscopic peritoneal dialysis catheter placement - a single tertiary center experience

Novel method in mice to evaluate left atrial (LA) systolic contribution to left ventricular volume (LV) using pressure-volume (PV) loops

Abstract Background LA myopathy is a critically important non-LV contributor to the progression of HFpEF (heart failure with preserved ejection fraction) in patients and is associated with a severe phenotype, leading to impaired cardiac output reserve and reduced exercise capacity. In normal humans LA systole contributes ~20% of total LV filling, but with HFpEF, this contribution decreases to &amp;lt;16% with a greater reliance on this contribution to LV filling. Purpose We sought to investigate LA function as a critical component of cardiac function analysis by utilizing the LV pressure signal to identify and quantify the contribution of volume during LA systole to the total LV volume in mice with HFpEF. Methods Hypertension (HTN)-associated HFpEF C57BL/6J mice were subjected to chronic aldosterone infusion and 1% NaCl for 4 weeks (SAUNA model). Obesity after a high fat diet (HFD: 60% fat diet) for 16 weeks followed by the SAUNA protocol, induced HTN and obesity associated HFpEF. Blood pressure was monitored weekly. Mice were anesthetized with isoflurane, intubated, chest opened to expose the heart and allow placement of a PV catheter (Transonic) which was introduced into the LV via apical stab with a 27G needle. Calibration of the PV catheter was performed according to the manufacturer’s instructions. Atrial systole was identified using 2nd order derivative of the LV pressure signal. Contribution of LA systole was calculated using volume at the beginning of LA systole identified by the 2nd order derivative of the LV pressure signal and subtracting from the LV end diastolic volume. The % of LA systole contribution was calculated as a % of the total LV stroke volume. Data was analyzed with LabChart pro software (AD Instruments). Results SAUNA mice had normal LVEF, moderate HTN and lung congestion. PV relationships demonstrated Tau was impaired in HFpEF vs. control mice (14±1 vs. 10±0.5 ms) with a shift of the PV loop to the left (Fig. A.) In control mice, the atrial systole contributed 39± 4% to LV volume and was impaired in HFpEF mice 20± 3% a 1.95-fold reduction (P&amp;lt;0.01). Importantly atrial systole contribution was increased in obese mice 53±5 %. However, the combination of obesity and HTN, both common comorbidities in HFpEF, resulted in a reduced LA systole contribution by 1.43-fold to 37± 9%, (P&amp;lt;0.005; Fig B). Conclusion A novel method of % atrial systole from LV PV loop using 2nd order derivative to quantify the volume contribution of atrial systole to total LV stroke volume was identified in mice. LA dysfunction was present in murine HTN-associated HFpEF with/without obesity.

Pulsed field ablation using additional mapping and substrate modification to treat atrial fibrillation - one year outcome comparison

Abstract Background Pulsed field ablation (PFA) is a relatively new non-thermal form of ablation employing irreversible cell electroporation as an alternative to radio-frequency ablation. Conventional use of PFA relies on fluoroscopy. Electro-anatomical and voltages mapping (EAM) may potentially provide refinement of PFA via ablation of non-PV targets and accurate localisation of catheter placement. Currently there is limited data on the efficacy of the use of voltages criteria of EAM in conjunction PFA in the treatment of atrial fibrillation. Objective The aim of our study was to determine the effect on atrial arrhythmia recurrence with the use of EAM with PFA in patients requiring atrial fibrillation ablation. Methods This single centre retrospective observational analysis included one hundred patients with symptomatic AF (paroxysmal and persistent) undergoing ablation for the first time. Fifty patients underwent PFA-PVI alone and fifty patients underwent PFA-PVI with EAM. Data were obtained on patient characteristics, outcomes, procedure details and complications up to one year. A blanking period of three months was used post-ablation. For rhythm monitoring we utilised ECGs and holters at three, six, nine and twelve months and twenty-four hour holter monitoring at six and nine months. We also used remote monitoring in between these periods to record any symptomatic episodes atrial arrhythmias. Results Baseline patient characteristics are represented in Table 1. Despite having no significant difference in category of AF between groups (Paroxysmal, persistent, longstanding persistent) the mapping group were significantly older (68.2 years ± 10.2 vs 60.1 ± 11.11; p=0.01), longer duration of documented atrial fibrillation (45.9 ± 50 vs 28.6 ± 38 months; p=0.038), higher risk for CV events with CHA2DS2-VASc score (2.2 ± 1.5 vs 1.42 ± 1.2; p=0.04), however, procedure times were greater in the PVI and mapping group (72.8 ± 6.2 vs 41.1 ± 17 minutes; p=0.03). Successful PVI was achieved acutely in all patients upon voltage guided mapping validation and most importantly 1 year follow up revealed comparable outcome in both groups (Fig 1). Conclusion Patients who underwent PFA with mapping were older, greater co-morbidity and longer duration of AF burden. Yet, the addition of EAM with PFA did demonstrate equivalent achievement of sinus rhythm and was relatively high as higher than 80 % at one year follow up. This study may suggest a preference to using EAM in patients who may be deemed to be older and have a greater co-morbidity. It emerges as a great hope to safer approach and successful intervention to reduce AF burden.mapping vs PVI onlyGraph showing one year follow up

The impedance drop early after energy delivery predicts steam pops during radiofrequency ablation

Abstract Background Steam pops during radiofrequency ablation (RFA) can cause serious complications. However, predictive factors for steam pops remain unclear. Purpose To investigate predictors for steam pops. Methods An in vitro experiment was performed using fresh bovine left ventricular myocardium. A myocardium cut into 4-5 cm slabs was fixed at the bottom of a constant temperature bath with temperature adjusted to 36.5 degrees Celsius, and a non-pulsatile flow rate of 5 L/min was generated. Using the catheter with a laser-cut 8Fr4.0mm flexible tip, RFA was applied at 30W, 60 seconds, perpendicular catheter placement to the tissue at various contact forces (5, 10, 20, 30, 40, 50g). A total of 138 lesions were created by applying RFA 23 times at each setting. Lesion depth and width were measured after RFA. Results Steam pops were observed in 49 of 138 lesions (36%). The higher impedance decrease in the first 5 seconds (-21.0±11.0Ω vs. -7.6±8.5Ω, P&amp;lt;0.0001), the larger impedance drop from initial to minimum impedance (if steam pop occurred, minimum impedance before steam pop was applied) (-28.9±13.0Ω vs. -13.1±12.9Ω, P&amp;lt;0.0001), higher initial impedance (132±48Ω vs. 87±38Ω, P&amp;lt;0.0001), power regulation by temperature control (44.9% vs 4.5%, P&amp;lt;0.0001), higher contact force (31.2±14.9g vs. 22.9±15.9g, P=0.0030), larger LSI (6.8±2.1 vs. 7.5±1.8, P=0.0037) were associated with steam pops. In multivariate analysis, the high impedance drops in the first 5 seconds (OR 2.0 for each 5Ω increase, 95%CI 1.0-1.3; P=0.033) and the power regulation by temperature control (OR 7.3, 95%CI 2.2-29.9; P=0.001) were independently related. In ROC curve analysis of the impedance drops in the first 5 seconds, an optimal cut-off value of steam pops was 8.0Ω (AUC 0.85, sensitivity 88%, specificity 73%) (figure 1). Steam pops were predicted with a sensitivity of 45% and specificity of 97% using both the impedance drop ≥ 8.0Ω in the first 5 seconds and power regulation by temperature control. Lesion depth and width were associated with total impedance reduction in lesions with an impedance drop &amp;lt; 8.0Ω during the first 5 seconds (R²=0.14, P=0.0012 with depth, R²=0.21, P&amp;lt;0.0001 with width), while were not associated with in lesions with an impedance drop ≥ 8.0Ω (figure 2). Conclusion The impedance drop early after RF energy delivery may predict steam pops during RFA.

Accidental Subclavian Artery Catheterization After Central Venous Catheter Placement

Accidental Subclavian Artery Catheterization After Central Venous Catheter Placement

End-tidal concentration of sevoflurane for optimal surgical conditions in pregnant sheep: a pragmatic approach to a retrospective observational study.

The aim of this pragmatic approach to retrospective observational study was to identify the end-tidal concentration of sevoflurane which was associated with optimal surgical conditions (i.e., absence of any movement, coughing and straining) in 127 pregnant sheep. Optimal surgical conditions were observed in 90% of the ewes with an end-tidal concentration of sevoflurane of 2.4 Vol-% [95% CI: 2.2; 2.8] during minimal-mild nociceptive stimuli (placement of arterial catheter, bladder catheter, shaving), with 4.4 Vol-% [95% CI: 4.0; 5.2] during maternal laparotomy and hysterotomy and with 4.4 Vol-% [95% CI: 3.9; 5.8] during subsequent manipulation of the uterus and fetal surgery.

Cerebral haemodynamics and intracranial pressure during haemorrhagic shock and resuscitation with total endovascular balloon occlusion of the aorta in an animal model.

To assess changes of cerebral haemodynamic and intracranial pressure (ICP) in animals, with or without elevated ICP, during controlled haemorrhagic shock and resuscitation with Total REBOA (tREBOA). In 22 anaesthetized and normoventilated pigs, after placement of catheters for monitoring invasive proximal blood pressure (pMAP), ICP, and vital parameters, and 60min stabilisation phase, a controlled haemorrhagic shock (HS), was conducted. In 11 pigs (EICPG), an elevated ICP of 25-30 mmHg at the end HS was achieved by simulating an epidural mass. In 11 pigs (NICPG), the ICP was normal. tREBOA was then applied for 120min. The changes of pMAP and ICP were followed, and cerebral perfusion pressure (CPP) calculated. The integrity of the autoregulation was estimated using a calculated Modified-Long Pressure Reactivity Index (mL-PRx). After stabilisation, hemodynamics and physiological parameters were similar and normal in both groups. At the end of the HS, ICP was 16 mmHg in NICPG vs. 32 in EICPG (p = 0.0010). CPP was 30 mmHg in NICPG vs. 6 mmHg in EICPG (p = 0.0254). After aorta occlusion CPP increased immediately in both groups reaching after 15min up to104 mmHg in NICPG vs. 126 mmHg in EICPG. Cerebrovascular reactivity seems to be altered during bleeding and occlusion phases in both groups with positive mL-PRx. The alteration was more pronounced in EICPG, but reversible in both groups. tREBOA is lifesaving by restoration the cerebral circulation defined as CPP in animals with HS with normal or elevated ICP. Despite the observation of short episodes of cerebral autoregulation impairment during the occlusion, mainly in EICPG, tREBOA seems to be an effective tool for improving cerebral perfusion in HS that extends the crucial early window sometimes known as the "golden hour" for resuscitation even after a traumatic brain injury.

A case report on the choice of venous access after ectopic peripherally inserted central catheter in an upper limb of a patient with a second recurrence of right-side breast cancer.

Intravenous catheter placement in the healthy upper extremity is preferred for chemotherapy in patients with breast cancer. Common venous accesses are peripherally inserted central catheters (PICCs) and totally implantable intravenous port catheters (TIVPs). In this case, a patient with breast cancer had a history of infusion port placement through the left internal jugular vein, with ipsilateral innominate vein stenosis after placement. The patient was re-treated with a PICC placed ectopically through the left upper limb into the intrathoracic vein. After multidisciplinary consultation, a transfemoral PICC combined with intracavitary electrocardiography (IC-ECG) was performed to establish venous access. This case can assist PICC catheterization nurses in developing optimal venous access strategies tailored to the specific situations of patients in similar situations. Through adequate evaluations and optimal selection of venous access, the success rate of disposable catheterization can be improved, and the risk of complications reduced. A 53-year-old female with breast cancer had a history of infusion port, with ipsilateral innominate vein stenosis after placement. The patient was re-treated with a PICC placed ectopically through the left upper limb into the intrathoracic vein. An axial computed tomography (CT) image before totally implantable venous access port (TIVP) placement and An axial CT 103 days after TIVP placement shows diffuse stenosis of the left innominate vein, associated with infusion port placement through the left internal jugular vein. After multidisciplinary consultation, a transfemoral PICC combined with intracavitary electrocardiography (IC-ECG) was performed to establish venous access. The patient's lower limb PICC was left in place for 201 days with no complications, completing the full treatment cycle. This case presents a rare and insightful clinical scenario. For patients with a history of infusion port placement, particularly via the left internal jugular vein, careful analysis of the innominate vena cava and examination of chest wall vein exposure are essential to determining the optimal vascular access strategy.