Journal of Neonatal-Perinatal Medicine 11 (2018) 101–104 DOI:10.3233/NPM-181726 IOS Press 101 Case Report Extravasation of total parenteral nutrition into the liver from an upper extremity peripherally inserted central venous catheter Arpit Gupta a,b , Alok Bhutada b , Miheret Yitayew b and Shantanu Rastogi b,* a Division of Neonatology, Maimonides Infants and Children’s Hospital, Brooklyn, NY, USA b Division of Neonatology, NYU School of Medicine, New York, NY, USA Received 16 February 2017 Revised 4 September 2017 Accepted 19 September 2017 Abstract. Peripherally inserted central catheters (PICC) are the mainstay of central venous access in preterm infants, and one of the common procedures performed in neonatal intensive care unit (NICU). Complications of PICC include infection, mechanical dysfunction, thrombosis, migration, and extravasation of the infusate. In this report, we describe a case of PICC inserted from an upper extremity with migration into the inferior vena cava (IVC) and the hepatic vein associated with extravasation of the total parenteral nutrition (TPN) into the peritoneum and the liver. This case highlights the vigilance required not only to insert but for the maintenance of PICC to prevent complications associated with migration of PICC. Keywords: Preterm infant, PICC, central catheter, hyperalimentation, malposition, liver abscess, necrotizing enterocolitis 1. Introduction PICC are widely used in the NICU for long-term venous access mainly to deliver total parenteral nutri- tion. Common sites of PICC insertion in neonates are veins in the upper extremity, lower extremity and in the scalp. Recent studies showed no difference in the overall incidence of catheter related complication rate between upper extremity and lower extremity PICC insertion sites but extravasation was more often with lower extremity insertion [1, 2]. Catheter migration * Address for correspondence: Shantanu Rastogi, MD, MMM, Albert Einstein College of Medicine, Maimonides Infant and Chil- dren’s Hospital, 4802 Tenth Ave, K-113, Brooklyn, NY 11219, USA. Tel.: +1 718 283 8853; E-mail: srastogi@maimonidesmed. org. and extravasation of infusate into the pleural space, pericardial space, abdominal cavity, and spinal canal has been reported previously as a complication of PICC [3]. In most of the reported cases the central catheter was inserted in the lower extremities but in our patient catheter tip migrated into the IVC from an upper extremity inserted PICC, which is unusual and has not been reported earlier. 2. Case report An Asian baby boy born to 30-year-old G4P0031 mother with severe preeclampsia at 28 weeks of ges- tation by cesarean section. Baby was appropriate for gestational age with birth weight was 980 grams. 1934-5798/18/$35.00 © 2018 – IOS Press and the authors. All rights reserved