A Silent Threat of Migrating PICC Line and Cardiac Tamponade in a 26-Week Preemie: Case Report

A peripherally inserted central catheter (PICC) is frequently used for long-term intravenous access in the neonatal intensive care unit (NICU), often for neonates who require continuous administration of medications, nutrition, or fluids. A female infant born at 26 weeks, weighing 774 grams, required a PICC line for nutrition and medication administration. On the sixth day of life, the baby experienced sudden cardiorespiratory deterioration requiring resuscitation. Bedside echocardiography revealed pericardial effusion with cardiac tamponade. Urgent pericardiocentesis was performed, draining 10 cc of milky fluid consistent with total parenteral nutrition. A chest radiograph confirmed migration of the PICC line towards the right atrial wall. Following pericardiocentesis and PICC removal, the baby’s condition improved, leading to successful extubation and eventual discharge at 4 months of age. This case emphasises the significance of maintaining a vigilant awareness of potential problems associated with PICCs in newborns, specifically pericardial effusion and cardiac tamponade. These issues can lead to rapid fatality if not properly identified and treated. Timely identification, prompt discontinuation of infusions, and expedited pericardiocentesis are vital therapies that can potentially save lives in such situations.