A rare yet preventable complication of lower extremity PICC malposition in an extreme preterm: Implications for enhanced procedural imaging standards

Abstract

Peripherally inserted central catheter (PICC) malposition is an underrecognized complication among neonatologists, especially when inserted in the lower extremity. In this report, we describe a rare abdominal wall complication of PICC placement through the saphenous vein in an extreme preterm, manifested clinically by hypoglycemia and a seemingly abdominal wall abscess. It was only after a lateral X-ray cross-table view of the abdomen that the abdominal wall collection was found to be a total parenteral nutrition (TPN) content extravasation, as the PICC tip was located inside the abdominal wall, which mandated its immediate removal. The patient’s condition improved markedly afterward, leaving only a minor abdominal scar. Our case highlights the necessity of acquiring both anteroposterior and lateral X-ray images following PICC placement in the lower extremities to verify the correct catheter positioning and avoid potential complications.