Spontaneous PICC migration after cardiac surgery: a case report.

Background: Peripherally inserted central catheters (PICCs) are frequently used in cardiac surgery patients to provide reliable long-term venous access for vasoactive medications, parenteral nutrition, and prolonged intravenous therapies. Although PICCs are associated with fewer complications than traditional central venous catheters, spontaneous catheter migration remains an uncommon but clinically important event that may lead to catheter malfunction or vascular injury. Case summary: We report the case of a 73-year-old man with multivessel coronary artery disease who underwent coronary artery bypass grafting ×3 with left atrial appendage ligation. A PICC placed preoperatively through the right basilic vein had its tip confirmed at the cavoatrial junction. On postoperative day 7, the patient developed haemodynamically unstable ventricular tachycardia following a prolonged coughing episode and underwent synchronized cardioversion. A chest radiograph obtained 6 h after prior confirmation of appropriate positioning demonstrated upward migration of the PICC tip into the right internal jugular vein. The catheter was removed and replaced without complication. Discussion: This case highlights postoperative coughing and synchronized cardioversion as potential contributors to PICC migration in cardiac surgery patients and underscores the importance of reassessing catheter position following high-risk events to prevent complications related to catheter malposition.