PICC insertion in the sitting position for a patient with congestive heart failure: A case report

RATIONALE: A peripherally inserted central catheter (PICC) is typically inserted with the patient in the supine position. Here, we placed a PICC in a patient in the sitting position, in order to treat congestive heart failure. PATIENT CONCERNS: A 65-year-old man was diagnosed with end-stage lung cancer. He had experienced septic shock and was medicated with continuous infusion of noradrenaline through a peripheral vein, in order to maintain sufficient blood pressure. However, indwelling peripheral venous catheters were difficult to place and maintain. DIAGNOSIS: The patient experienced orthopnea due to congestive heart failure and could not assume any other position. INTERVENTIONS: An anesthesiologist performed PICC placement while the patient was in the sitting position, using ultrasound guidance. OUTCOMES: The patient's orthopnea was slightly ameliorated, and he was able to sleep at night. LESSONS: The technique of inserting a PICC in the sitting position is simple and feasible. This approach may be useful for patients in whom central venous access is needed, but the supine position cannot be achieved.