PMC5412634_01
Chest radiograph depicting a peripherally inserted central venous catheter (white arrow) through the left brachial vein.
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Antibiotics and antifungals were administered via a peripherally inserted CVC in the left brachial vein, with the tip positioned in the superior vena cava and right atrial junction (Figure 1).
Chest radiograph depicting the fractured peripherally inserted central venous catheter following lead extraction (white arrows identify the fractured catheter with the distal now embedded deep into the right atrium). Also visible in this radiograph is a new temporary pacing lead that was inserted via direct axillary venous puncture access in a location outside and above the infected pacemaker pocket; the temporary pacing lead was connected to the now-externalized old pacemaker generator that was secured to the skin outside of the infected pacemaker pocket. This temporary pacing lead was necessary for the duration of antibiotic therapy prior to the new system implant because the patient was pacemaker dependent; it was placed on the same side as the infection to avoid vascular injury and localized infection in the contralateral venous access site where the new permanent pacemaker system will be implanted when the infection resolves.
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As the patient was pacemaker dependent, a temporary pacing lead was implanted for backup pacing pending the implant of a new dual-chamber pacemaker system (Figure 2).