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

## TL;DR

A rare case of a central venous catheter being misplaced into the renal vein during ultrasound-guided insertion is reported, highlighting the importance of post-insertion imaging.

## Contribution

This is the first reported case of a PICC catheter malpositioned from the superficial femoral vein into the contralateral renal vein.

## Key findings

- The catheter tip was found in the contralateral renal vein after ultrasound-guided insertion.
- The catheter retained functionality after being pulled out based on X-ray findings.
- Post-insertion X-ray is emphasized as crucial for safety in superficial femoral vein PICC placements.

## Abstract

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.

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.

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.