Retrieval of a fractured PICC fragment following umbilical venous insertion in a preterm infant: a case report

Background: Due to the immaturity of their organs, preterm infants often require central venous access to ensure effective treatment and nutritional support. Although umbilical vein catheterization is a commonly used method, rare but serious complications such as catheter fracture and migration can occur during the procedure, posing significant challenges and high risks to manage. Methods: This report describes a case of a male preterm infant with a gestational age of 32 weeks who required a peripherally inserted central catheter (PICC device inserted via the umbilical vein as an off-label approach) for critical care. During catheter removal, the catheter fractured and migrated to the right atrium. Given the high risk of surgical intervention, an endovascular approach via the femoral vein was chosen for foreign body retrieval. Under fluoroscopic guidance using a digital subtraction angiography (DSA) system without contrast, the fractured catheter segment was successfully removed using a multi-wire system and catheter pathway construction combined with a lumen snare system. Results: The procedure was performed smoothly, with stable vital signs observed throughout the operation and no perioperative arrhythmias. Postoperative imaging confirmed the absence of thrombus formation or residual catheter fragments, and the infant exhibited favorable recovery. Conclusion: This case demonstrates that minimally invasive endovascular retrieval is a safe and effective alternative for managing intracardiac foreign bodies in preterm infants, particularly those at high surgical risk. The refined technique without contrast agent use further enhances procedural safety for such high-risk neonates, offering valuable clinical insights for managing similar catheter-related complications.