Research progress on identification and management of malpositioned central venous access device tip into the azygos vein

doi:10.3761/j.issn.0254-1769.2026.04.019

Chinese Journal of Nursing ›› 2026, Vol. 61 ›› Issue (4): 566-570.DOI: 10.3761/j.issn.0254-1769.2026.04.019

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Research progress on identification and management of malpositioned central venous access device tip into the azygos vein

LIU Chunli¹(), TENG Xue², ZHANG Liuliu²^,^*(), YANG Bo³, ZHANG Maomao², LI Xiaoxu², YU Rong², SHI Ruchun¹

1. Vascular Access Center，Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University，Nanjing 210009，China
2. Nursing Department，Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University，Nanjing 210009，China
3. Medical Image Center，Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University，Nanjing 210009，China

Received:2025-02-11 Online:2026-02-20 Published:2026-02-06
* Corresponding author: ZHANG Liuliu，Email：liuliuzhang2021@163.com
Funding program:
Medical Research General Project of Jiangsu Commission of Health(M2021114)

中心静脉血管通路尖端异位奇静脉识别及处理的研究进展

刘春丽¹(), 滕雪², 张柳柳²^,^*(), 杨波³, 章毛毛², 李晓旭², 于蓉², 施如春¹

1.江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院血管通路中心南京市 210009
2.江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院护理部南京市 210009
3.江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院影像中心南京市 210009

通讯作者: 张柳柳，E-mail：liuliuzhang2021@163.com
作者简介:刘春丽：女，硕士，副主任护师，E-mail：13951710545@163.com
基金资助:
江苏省卫健委医学科研项目(M2021114)

Abstract

Abstract:

Malpositioned central venous access device（CVAD） tip into the azygos vein can lead to complications such as venous perforation，thrombosis，and tracheo-azygos fistula. Early identification and management is essential for ensuring the safety of intravenous therapy. This review article summarizes the current status，adverse outcomes，risk factors，detection methods，and management strategies regarding malpositioned CVAD tip into the azygos vein，aiming to provide references for clinical practice.

Key words: Peripherally Inserted Central Catheter, Totally Implantable Venous Access Port, Central Venous Catheter, Malposition, Azygos Vein, Complications, Review, Nursing Care

摘要：

中心静脉血管通路尖端异位奇静脉可导致静脉穿孔、血栓形成、气管奇静脉瘘等并发症，尽早识别及处理可保障静脉治疗安全。该文对中心静脉血管通路尖端异位奇静脉的发生现状、不良结局、影响因素、识别方法、处理策略等内容进行综述，以期为临床实践提供参考。

关键词: 经外周置入中心静脉导管, 完全植入式静脉输液港, 中心静脉导管, 异位, 奇静脉, 并发症, 综述, 护理

LIU Chunli, TENG Xue, ZHANG Liuliu, YANG Bo, ZHANG Maomao, LI Xiaoxu, YU Rong, SHI Ruchun. Research progress on identification and management of malpositioned central venous access device tip into the azygos vein[J]. Chinese Journal of Nursing, 2026, 61(4): 566-570.

刘春丽, 滕雪, 张柳柳, 杨波, 章毛毛, 李晓旭, 于蓉, 施如春. 中心静脉血管通路尖端异位奇静脉识别及处理的研究进展[J]. 中华护理杂志, 2026, 61(4): 566-570.

References 38

[1]	Duwadi S, Zhao QH, Budal BS. Peripherally inserted central catheters in critically ill patients-complications and its pre-vention:a review[J]. Int J Nurs Sci, 2018, 6(1):99-105.
[2]	Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy stan-dards of practice[J]. J Infus Nurs, 2021, 44(1s):1-224.
[3]	沈婷, 余婷, 聂玲, 等. 新生儿PICC导管尖端继发性异位预防和处理的最佳证据总结[J]. 中华护理杂志, 2023, 58(18):2273-2281. DOI URL
	Shen T, Yu T, Nie L, et al. Summary of the best evidence for the prevention and management of PICC secondary catheter tip malposition in neonates[J]. Chin J Nurs, 2023, 58(18):2273-2281. DOI URL
[4]	Kampouroglou G, Noutsos G, Skandalakis P, et al. Azygos vein cannulation after catheterisation of the left internal jugular vein in a toddler[J]. BMJ Case Rep, 2019, 12(1):bcr-2018-227930.
[5]	Feng YP, Liu YQ, Xu SX, et al. On the way to the azygos vein:a road of return rather than ruined[J]. J Cardiothorac Surg, 2024, 19(1):259. DOI
[6]	Wang MJ, Xu L, Feng Y, et al. Misplacement of a central ve-nous catheter into azygos vein via the right internal jugular vein[J]. J Vasc Access, 2021, 22(6):1004-1007. DOI URL
[7]	Andrews MH, Chisholm BD. Spontaneous migration of a porta-cath into the azygos vein with subsequent development of a tracheo-azygos fistula[J]. J Med Imaging Radiat Oncol, 2015, 59(2):200-203. DOI URL
[8]	王雅萍, 赵林芳, 曹秀珠. 25例PICC继发奇静脉异位患者的护理[J]. 中华护理杂志, 2020, 55(6):920-922. DOI URL
	Wang YP, Zhao LF, Cao XZ. Nursing care of 25 patients with PICC secondary malposition of azygos vein[J]. Chin J Nurs, 2020, 55(6):920-922.
[9]	Bankier AA, Mallek R, Wiesmayr MN, et al. Azygos arch can-nulation by central venous catheters:radiographic detection of malposition and subsequent complications[J]. J Thorac Imaging, 1997, 12(1):64-69. DOI URL
[10]	Marcy PY, Guiffant G, Merckx J, et al. Diagnosis of azygos ca-theter misplacement[J]. J Vasc Access, 2016, 17(5):e148-149. DOI URL
[11]	Haygood TM, Malhotra K, Ng C, et al. Migration of central lines from the superior vena cava to the azygous vein[J]. Clin Ra-diol, 2012, 67(1):49-54.
[12]	薛嵋, 陆箴琦, 毛静玉, 等. 经外周中心静脉置管误入奇静脉1例分析[J]. 上海护理, 2011, 11(2):86-88.
	Xue M, Lu ZQ, Mao JY, et al. Analysis of a case of misplace-ment of azygos vein by catheterization through peripheral central vein[J]. Shanghai Nurs, 2011, 11(2):86-88.
[13]	申屠英琴, 赵锐祎, 李爱萍, 等. PICC异位至奇静脉8例的识别与处理[J]. 护理与康复, 2015, 14(6):563-565.
	Shentu YQ, Zhao RY, Li AP, et al. Identification and treat-ment of 8 cases of ectopic PICC to azygos vein[J]. J Nurs Re-habil, 2015, 14(6):563-565.
[14]	Gu JL, Wei GL, Li LC, et al. Catheter allotopia with totally implantable access port:a report of three cases and literature review[J]. Clin Case Rep, 2020, 9(1):128-132. DOI URL
[15]	Fernando R, Lee YJ, Khan N, et al. Delayed migration of a peripherally inserted central venous catheter to the azygos vein with subsequent perforation[J]. BJR Case Rep, 2016, 2(2):20150315.
[16]	Mysona DP, Lassiter RL, Walters KC, et al. Azygos vein erosion:a potential complication of central venous access[J]. J Pediatr Surg Case Rep, 2017,24:1-4.
[17]	Frias PF, Cross CG, Kaufman CS, et al. Port malposition in the azygos vein resulting in a veno-broncho and broncho-eso-phageal fistula:a case report[J]. J Vasc Access, 2022, 23(4):632-635. DOI URL
[18]	Zhang HF, Jiang B, Zhou H, et al. Spontaneous migration of a peripherally inserted central catheter into the azygos vein in esophageal cancer patients during surgery[J]. J Vasc Access, 2015, 16(6):537-539. DOI PMID
[19]	李艺红. 1例PICC继发奇静脉异位导致开胸手术的原因及对策分析[J]. 现代医药卫生, 2023, 39(增刊):222-223.
	Li YH. Analysis on the causes and countermeasures of a case of thoracotomy caused by ectopic azygos vein secondary to PICC[J]. J Mod Med Health, 2023, 39(Suppl 2):222-223.
[20]	Marcy PY, Guiffant G, Flaud P. Catheter tip displacements at power PICC CT injection[J]. AJR Am J Roentgenol, 2014, 203(6):W742-W743.
[21]	Liu WN, Wei W, Wang Y, et al. Spontaneous migration of peripherally inserted central catheter into the azygos vein during postoperative gastrointestinal dysmotility:a case report[J]. Medicine(Baltimore), 2023, 102(22):e33921.
[22]	Haygood TM, Malhotra K, Ng C, et al. Migration of central lines from the superior vena cava to the azygous vein[J]. Clin Ra-diol, 2012, 67(1):49-54.
[23]	Baskin KM, Jimenez RM, Cahill AM, et al. Cavoatrial junction and central venous anatomy:implications for central venous access tip position[J]. J Vasc Interv Radiol, 2008, 19(3):359-365. DOI PMID
[24]	郑雪贞, 陈真, 郑素惠, 等. 耐高压注射型PICC导管异位的原因分析及处理对策[J]. 中西医结合护理(中英文), 2018, 4(6):68-71.
	Zheng XZ, Chen Z, Zheng SH, et al. Cause analysis of mis-placement of high pressure resistant injectable PICC and related countermeasures[J]. Nurs Integr Tradit Chin West Med, 2018, 4(6):68-71.
[25]	Luo MN, Wu ZM, Fan YY. Peripherally inserted central cathe-ter malposition into the azygos vein:a case series report and review of the literature[J]. J Vasc Access, 2025, 26(3):975-981. DOI URL
[26]	Talari G, Talari P, Parasramka S, et al. Recurrent migration of peripherally inserted central catheter into the azygos vein[J]. BMJ Case Rep, 2018,2018:bcr2017221184.
[27]	Sherif MM, Hall R, Schauer CKMW. Azygos vein thrombosis secondary to a peripherally inserted central catheter (PICC)[J]. J Vasc Access, 2015, 16(4):e82-83. DOI URL
[28]	Carlon R, Chiarandini P, Pasqualucci A. Secondary migration of a central venous catheter. A case report[J]. Minerva Anes-tesiol, 2003, 69(12):927-931.
[29]	Lim BK, Balasubramaniam BS. Dislodgement of a power-inje-ctable peripherally inserted central catheter after power injection:a case report[J]. J Assoc Vasc Access, 2013, 18(1):27-29. DOI URL
[30]	Lee JTL, Ricketts J. Displacement of a power-injectable PICC following computed tomography pulmonary angiogram[J]. Ra-diol Case Rep, 2017, 12(4):690-692.
[31]	Morden P, Sokhandon F, Miller L, et al. The role of saline flush injection rate in displacement of CT-injectable peripherally inserted central catheter tip during power injection of con-trast material[J]. AJR Am J Roentgenol, 2014, 202(1):W13-W18.
[32]	谷小燕, 付雪娇, 胡芬, 等. 利用支撑导丝排除PICC导管反折异位的效果[J]. 中国实用护理杂志, 2019, 35(22):1717-1721.
	Gu XY, Fu XJ, Hu F, et al. Elimination of PICC catheter refolding malposition by using the supporting guide wire[J]. Chin J Pract Nurs, 2019, 35(22):1717-1721.
[33]	Wang YP, Zhao LF. Diagnosis and management of secondary malposition of PICC into the azygos vein[J]. J Vasc Access, 2022, 23(3):450-454. DOI URL
[34]	耿才正, 陈姬雅, 王建铭. 上腔静脉X线投影测量与患者相关因素的探讨[J]. 医学影像学杂志, 2012, 22(5):768-770.
	Geng CZ, Chen JY, Wang JM. Studying and analyzing the relationship between X-ray cephalometry of superior vena cava and patient-related factors[J]. J Med Imag, 2012, 22(5):768-770.
[35]	Haygood TM, Brennan PC, Ryan J, et al. Central venous line placement in the superior vena cava and the azygos vein:differentiation on posteroanterior chest radiographs[J]. AJR Am J Roentgenol, 2011, 196(4):783-787. DOI URL
[36]	王龙君, 王丹, 方艳艳, 等. 超声与腔内心电图引导44例危重症患儿PICC尖端定位的护理[J]. 中华护理杂志, 2021, 56(9):1380-1382. DOI URL
	Wang LJ, Wang D, Fang YY, et al. Nursing care of critically ill children with PICC tip positioning guided by ultrasound and intracardiac electrogram[J]. Chin J Nurs, 2021, 56(9):1380-1382. DOI URL
[37]	封凤, 徐红霞, 王铃, 等. 44例PICC原发性上腔静脉内异位患者的护理[J]. 中华护理杂志, 2021, 56(6):904-906. DOI URL
	Feng F, Xu HX, Wang L, et al. Nursing care of 44 cases of PICC patients with initial catheter malposition in superior vena cava[J]. Chin J Nurs, 2021, 56(6):904-906. DOI URL
[38]	Mao CM, Shi YY, Wang MX, et al. Spontaneous migration of a peripherally inserted central catheter into the azygos vein and accidental transection during thoracic surgery:a case report[J]. Asia Pac J Oncol Nurs, 2024, 11(12):100614. DOI URL

Research progress on identification and management of malpositioned central venous access device tip into the azygos vein

中心静脉血管通路尖端异位奇静脉识别及处理的研究进展

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