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

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.