Total parenteral nutrition in the pleural space

PICCs are commonly used for delivery of TPN in neonates; the ideal PICC line position is within the region of the superior vena cava/right atrium confluence, and migration needs to be carefully monitored for. PICC lines that reside in an intermediate position (subclavian or axillary vein) are at 100% increased risk of complications, including pleural effusions,1 with the incidence of complications ranging from 0.3% to 2%.2 This patient had an intermediately placed PICC that was malpositioned despite acceptable position on chest X-ray. In future this could be identified earlier using ultrasound imaging or a contrast X-ray prior to using the line.3 Learning points To image intermediate peripherally inserted central catheter (PICC) line placement using ultrasound or X-ray with contrast to identify possible malposition prior to using the line.