PICC Insertion could be an optimal choice of central venous access in prone position mechanically ventilated COVID-19 ARDS patient


PICC Insertion could be an optimal choice of central venous access in prone position mechanically ventilated COVID-19 ARDS patient


Ali Al Bshabshe1, Ali Abdullah Kablan2, Nasser Mohammed Alwadai3, Omprakash Palanivel3, Ghaida Nawi A. Alharthi4, Khloud Faleh S. Alahmari4, Hala Khamis S. Alghamdi4, Raghad Abdullah M. Brkout 4, Lamees Abdullah M. Brkout 4, Lama Abdullah M. Brkout 4

1Intensive Care Consultant, Aseer Central Hospital & Professor, Department of Medicine/Critical Care, College of Medicine, King Khalid University, Abha, Aseer Region, Saudi Arabia. 2Intensive Care Senior Specialist, Department of Intensive Care Unit, Aseer Central Hospital, Abha, Aseer Region, Saudi Arabia. 3Consultant Respiratory Therapist, Department of Respiratory Care Unit, Aseer Central Hospital, Abha, Aseer Region, Saudi Arabia. 4Medical Students, Department of Medicine, College of Medicine, King Khalid University, Abha, Aseer Region, Saudi Arabia.


During the management of critically ill covid-19 patients obtaining an appropriate centrally inserted central catheter (CICC) can be a prime necessity. Traditionally, a CICC is inserted in a supine position. However, a CICC may not be possible in some COVID-19 patients with severe hypoxia or sudden clinical deterioration who need urgent intubation and immediate proning. Therefore, CICC in pronated COVID-19 ARDS patients is challenging. Recent studies limited to case reports have shown that peripherally inserted central catheters (PICC) are safer in pronated ARDS patients. PICC lines minimize mechanical complications and lower catheter-related bloodstream infections when compared to standard CICC. However, there is a scarcity of evidence showing the efficacy of PICC in pronated COVID-19 ARDS patients, possibly due to the complex precautionary safety measures, insertion techniques, and expertise team deficit. Herein, we present a 57-year-old male as a case of COVID-19 ARDS, mechanically ventilated in a prone position with existing subcutaneous emphysema. Our case illustrates PICC insertion challenges in the prone position, ultrasound guidance in PICC insertion to comprehend the vein’s diameter for accurate vein needling in proportion to the external catheter diameter, and intracavitary electrocardiographic (ECG) navigation method to confirm catheter tip location. So that chest X-ray and radiology risk of contamination is avoided. Long-term research urged to validate the efficacy of PICC in this group of patients.


Keywords: Central Venous access devices (VAD) Central venous access devices (CVAD), Centrally inserted central catheter (CICC), peripheral inserted central catheter (PICC), Blood gas analyses (BGA), Subcutaneous emphysema (SE), Electrocardiography (ECG), Intracavitary electrocardiography (IC-ECG).


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Ali Al Bshabshe, Ali Abdullah Kablan, Nasser Mohammed Alwadai, Omprakash Palanivel, Ghaida Nawi A. Alharthi, Khloud Faleh S. Alahmari, Hala Khamis S. Alghamdi, Raghad Abdullah M. Brkout, Lamees Abdullah M. Brkout, Lama Abdullah M.Brkout. PICC Insertion could be an optimal choice of central venous access in prone position mechanically ventilated COVID-19 ARDS patient. International Journal of Case Reports, 2021 5:226. DOI: 10.28933/ijcr-2021-06-1507


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