Differential diagnosis of pediatric peripherally inserted central catheter malfunction

• Scalp or upper extremity PICC tip not positioned in the superior vena cava
• Lower extremity PICC tip not positioned in the inferior vena cava
• Lower extremity PICC tip positioned in the spinal canal causing neurosurgical emergency
• PICC tip in the right atrium can lead to erosion of PICC through atrium into pericardial space causing cardiac tamponade
• PICC placed in artery rather than in vein
• PICC perforation of vessel during placement
• PICC tip thrombosis which can extend into any adjacent vein

Approach to the differential diagnosis of peripherally inserted central catheter malfunction:

• Tip of scalp PICC and upper extremity PICC should be in the superior vena cava, tip of lower extremity PICC should be in the inferior vena cava, otherwise tip is malpositioned
• Note: upper extremity PICC tip position can vary depending on arm position
• Lower extremity PICC tip positioned within the spinal canal is malpositioned and can lead to neurosurgical emergency
• PICC tip in the right atrium can lead to erosion of PICC through atrium into pericardial space causing cardiac tamponade
• Suspect the PICC is placed in artery rather than in vein when catheter does not appear to have a normal venous course
• Suspect PICC perforation of vessel during placement when catheter does not appear to have a normal venous or arterial course
• PICC tip thrombosis which can extend into any adjacent vein may occur