Central vein stenosis detected during a second peripherally inserted central catheter placement in a patient with recurrent breast cancer: a case report

Central vein stenosis (CVS) can complicate peripherally inserted central catheter (PICC) placement by impeding catheter advancement and preventing achievement of an appropriate central tip position. On 23 January 2025, a 57-year-old female with recurrent right breast cancer was admitted for systemic anticancer treatment and required renewed long-term venous access. During a second PICC placement through the left basilic vein, catheter advancement was unexpectedly impeded, and venography confirmed left brachiocephalic vein stenosis with catheter coiling near the stenotic segment. A multidisciplinary team (MDT), including PICC specialist nurses, oncology physicians, cardiovascular surgeons, and ultrasound imaging experts, determined that further advancement across the left stenotic segment posed additional risk. The catheter was therefore withdrawn until the coiling resolved, leaving the tip in the left subclavian vein. After individualized assessment of the patient’s vascular anatomy, treatment requirements, and alternative vascular access options, the catheter was retained at this nonstandard tip position and managed with individualized anticoagulation and clinical surveillance. During approximately six months of follow-up, the patient experienced catheter dislodgement, but no clinically documented catheter-related thrombosis, infection, or drug extravasation occurred. The case highlights that unexpected resistance during PICC advancement may warrant assessment for central venous abnormalities even when peripheral veins appear patent. When CVS is encountered, catheter management should be individualized through MDT assessment, and retention of a PICC in a nonstandard tip position should be regarded as an exceptional strategy.