Bedside insertion of a peripherally inserted central catheter into a patient with BMI of 84.8 kg/m(2) using a magnetic tracking and electrocardiogram-based tip confirmation system: a case report

BACKGROUND: Peripherally inserted central catheters (PICCs) are typically placed under fluoroscopy. We used a magnetic tracking and electrocardiogram-based tip confirmation system for insertion of a PICC insertion in a morbidly obese patient at the bedside. CASE PRESENTATION: A 53-year-old female with severe obesity (height, 160 cm; weight, 217 kg; BMI, 84.8 kg/m(2)) was admitted to the intensive care unit. Both bilateral, inguinal, and cervical regions were covered with an excess of adipose tissue, making it difficult to place a central venous line. Since transferring her to fluoroscopy seemed dangerous, a PICC was inserted using Sherlock 3CG® TCS at the bedside. Magnetic sensor guidance failed due to the thick subcutaneous tissue her precordium, but intracavity electrocardiography could direct the tip to an appropriate position. CONCLUSION: We experienced bedside insertion of a PICC into a patient with BMI of 84.8 kg/m(2) patient using a Sherlock 3CG® TCS. Since the interaction between Sherlock 3CG® TCS and body habitus has not been investigated, further reports are needed.