Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter July 27, 2021

Parenteral nutrition extravasation into the abdominal wall mimicking an abscess

Natascha Pramhofer ORCID logo, Sebastian Sailer ORCID logo, Maria Magdalena Nöhammer, Bernhard Csillag, Simon Kargl ORCID logo and Gabriele Wiesinger-Eidenberger



Peripherally inserted central catheters (PICC) are used in the neonatal intensive care unit (NICU) setting for medication and nutrition administration. PICCs are easy to place and may remain inserted up to several weeks. Serious complications are rare. Cases of infection, dysfunction, thrombosis, malposition into other vessels, catheter migration, vessel erosion, perforation into pleura, pericardium, abdomen and even into the epidural space with extravasation have been reported [1, 2].

Case presentation

We present the case of a preterm infant with a right leg inserted PICC with the tip supposedly being placed in the external iliac vein with further catheter migration into the abdominal wall during the course of treatment.


Our patient developed extravasation of lipid infusion, which was initially misinterpreted as an abscess due to signs of local inflammation.

Corresponding author: Natascha Pramhofer, Department of Neonatology, Kepler University Hospital, Medical Faculty, JKU, Krankenhausstr. 26-30, 4020, Linz, Austria, E-mail:

  1. Research funding: None declared.

  2. Author contributions: Dr. Pramhofer und Dr. Sailer conceptualized the case report, collected the patient’s family’s consent, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Nöhammer and Dr. Csillag conceptualized the case report, reviewed and revised the manuscript. Dr. Kargl and Dr Wiesinger-Eidenberger conceptualized the case report and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Not applicable.


1. Barone, G, Pittiruti, M. Epicutaneo-caval catheters in neonates: new insights and new suggestions from the recent literature. J Vasc Access 2020;21:805–9. in Google Scholar PubMed

2. Pittiruti, M, Hamilton, H, Biffi, R, MacFie, J, Pertkiewicz, M. ESPEN guidelines on parenteral nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009;28:365–77. in Google Scholar PubMed

3. Paulson, P, Miller, K. Neonatal peripherally inserted central catheters: recommendations for prevention of insertion and postinsertion complications. Neonatal Netw 2008;27:245–57. in Google Scholar PubMed

4. Ainsworth, S, McGuire, W. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. In: Cochrane Neonatal Group, editor. Cochrane database of systematic reviews [Internet]. Hoboken, New Jersey: John Wiley & Sons, Inc.; 2015. [cited 2020 Nov 1]. Available from: in Google Scholar PubMed

5. Wrightson, DD. Peripherally inserted central catheter complications in neonates with upper versus lower extremity insertion sites. Adv Neonatal Care 2013;13:198–204. in Google Scholar

6. Ramasethu, J. Complications of vascular catheters in the neonatal intensive care unit. Clin Perinatol 2008;35:199–222. in Google Scholar PubMed

7. Knobel, RB, Meetze, W, Cummings, J. Case report: total parenteral nutrition extravasation associated with spinal cord compression and necrosis. J Perinatol 2001;21:68–71. in Google Scholar PubMed

8. Kylat, RI, Kuo, PH, Bedrick, AD, Witte, MH. Neonatal lymphedema from thoracic duct obstruction complicating percutaneous intravenous central catheterization. Lymphology 2017;50:67–72.Search in Google Scholar

9. Kolaček, S, Puntis, JWL, Hojsak, I, Braegger, C, Bronsky, J, Cai, W, et al.. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: venous access. Clin Nutr 2018;37:2379–91. in Google Scholar PubMed

10. Pettit, J. Assessment of infants with peripherally inserted central catheters: part 2. detecting less frequently occurring complications. Adv Neonatal Care 2003;3:14–26. in Google Scholar PubMed

Received: 2021-03-10
Accepted: 2021-07-01
Published Online: 2021-07-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Scroll Up Arrow