Unusual complication of peripherally inserted central venous catheter placement: the left pericardiophrenic vein

Excerpt

Understanding the venous anatomy of the thorax facilitates interpretation of catheter position (Fig. 1). In Fig. 1, the two brachiocephalic veins can be seen uniting to form the superior vena cava to the right of the heart. The left brachiocephalic vein, which drains the arm via the subclavian, also receives multiple smaller branches. These include the left first intercostal vein, superior intercostal vein, pericardiophrenic vein, internal thoracic (internal mammary) vein, persistent left superior vena cava, and the left thymic vein. The left pericardiophrenic vein, formed from the venous branches draining the superior aspect of the diaphragm and the pericardium, runs parallel to the left cardiac border and drains into the floor of the left brachiocephalic vein, approximately opposite the left internal jugular vein. It is this position that most likely allows a catheter from the internal jugular on occasion to be directed into the pericardiophrenic vein. The reader is referred to detailed discussions and illustrations by Currarino [1] and Wechsler et al. [2] on all these veins. Interestingly, most catheter migrations appear to be on the left side, possibly as a result of the greater number of veins.

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