Patient: Female, 58Final Diagnosis: Breast cancerSymptoms: NoneMedication: NoneClinical Procedure: Insertion of a peripherally inserted central catheter (PICC)Specialty: AnesthesiologyObjective:Unusual or unexpected effect of treatmentBackground:A peripherally inserted central catheter (PICC) causes few serious complications but can be malpositioned. To avoid malpositioning, ultrasound guidance is widely used. Here, we report the case of a patient who received a PICC that was inserted under ultrasound guidance, but the catheter tip accidentally entered the right inferior thyroid vein.Case Report:A 58-year-old woman was scheduled for reconstructive mammoplasty. After general anesthesia, a PICC was inserted via the right basilic vein. The PICC was inserted under guidance using a portable ultrasound machine with a high-frequency linear transducer. The tip of the guide wire and catheter were confirmed by ultrasound to be in the right subclavian vein, not in the right internal jugular vein, during insertion. However, the chest X-ray performed after the PICC insertion showed that the catheter had moved into the right inferior thyroid vein.Conclusions:Malpositioning of a PICC can occur into any small vein. Ultrasound should be used not only to avoid malpositioning into the IJV, but also to confirm the proper position of the catheter tip during PICC insertion.

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Ultrasound guided sciatic nerve block (SNB) at the popliteal fossa is performed with the lateral approach in the supine position or with the lateral or posterior approach in the prone position. When the sciatic nerve (SN) is blocked with the lateral approach in the supine position, the lower limb must be sufficiently elevated to enable adequate space around the knee joint for transducer application. When the SN is blocked in the prone position, the patients' position needs to be changed. We report a medial approach to the SNB at the popliteal fossa in the supine position with ultrasound guidance. Ten patients scheduled for elective knee or foot surgery participated in this study. Patients were placed in the supine position, with the hip and knee on the operated side flexed and the thigh externally rotated at approximately 45 degrees. A block needle was inserted in-plane with the transducer toward the SN bifurcation from the medial side of the thigh. The block performance time for SNB was 1.8 ± 0.5 min (1.3-3.1 min). All blocks were effective. Our medial approach to the SN in the supine position with ultrasound guidance does not require elevation of the patient's lower limb or a change in the patient's position.