# Correcting Peripherally Inserted Central Catheter Placement by External Manipulation of the Upper Limb Extremity

## TL;DR

A preterm infant's PICC catheter was successfully repositioned using external arm manipulation, avoiding invasive procedures.

## Contribution

Demonstrates external limb manipulation as a non-invasive method to correct PICC placement in neonates.

## Key findings

- External manipulation of the infant's arm repositioned the PICC tip into the superior vena cava.
- Arm positioning significantly affects PICC placement in neonates.
- Non-invasive adjustment techniques can replace invasive interventions for PICC correction.

## Abstract

Peripherally inserted central catheters (PICCs) play a critical role in neonatal intensive care units (NICUs), facilitating treatment in premature and critically ill neonates. However, achieving optimal PICC placement can present challenges, requiring meticulous monitoring and adjustment. Here, we describe the case of a 52-day-old, 1.9 kg preterm infant in the NICU requiring a central venous catheter for antibiotics and antifungals. Despite initial insertion into the basilic vein of the right forearm, imaging revealed the catheter's deviation into the right internal jugular vein. Leveraging the influence of arm position on catheter tip depth, external manipulation of the infant's right arm successfully repositioned the catheter tip into the superior vena cava (SVC). This case highlights the significant impact of arm positioning on PICC placement and underscores the efficacy of external extremity manipulation as a simple, non-invasive technique to adjust catheter position. Such innovative strategies offer promising alternatives to invasive interventions, emphasizing the importance of dynamic monitoring and adjustment techniques in neonatal PICC management.