Right ventricle migration of a peripherally inserted central catheter: case report and literature review

This study describes a case of fracture and migration of a peripherally inserted central catheter (PICC) identified as an electrode fragment during an endovascular procedure. It analyzes risk factors, mechanisms, and the role of diagnostic imaging for rapid fragment identification. A 65-year-old woman with colon carcinoma had a PICC placed for chemotherapy. Routine chest radiography revealed a linear foreign body near the cardiac silhouette. Computed tomography (CT) confirmed a migrated fragment in the right ventricle. Despite no symptoms, urgent intervention was required due to the intracardiac location. The fragment, identified as a catheter fragment from the PICC, was removed percutaneously using a loop snare system without complications, and the patient was discharged in good condition. Literature indicates that PICC fracture and migration are rare but serious, potentially causing arrhythmias, pulmonary embolism, infections, or valvular damage. Causes include defective materials, mechanical compression (e.g., pinch-off syndrome), improper placement/removal, or material wear. Symptoms vary from none to severe. Early diagnosis relies on radiological surveillance, with chest radiography as the initial step, followed by CT and echocardiography for precise localization. The percutaneous endovascular approach is the preferred treatment due to its efficacy and safety. This case underscores the importance of vigilant radiological follow-up, even in asymptomatic patients, to detect anomalies that could jeopardize safety. CT enabled rapid diagnosis and planning, while the endovascular procedure ensured safe fragment removal and quick recovery. The case highlights the need for healthcare professionals to monitor device integrity and functionality, emphasizing early diagnosis through advanced imaging and prompt intervention to ensure favorable outcomes in complex oncological patients.