Neonatal Cardiac Tamponade Related to Peripherally Inserted Central Catheter: A Rare Case Report

Background: Peripherally inserted central catheters (PICCs) are commonly used in neonatal intensive care units (NICUs) to provide prolonged intravenous access for preterm and critically ill infants. They are generally preferred over surgically placed central venous catheters because of easier insertion and, in some settings, lower infection rates. However, rare but life-threatening complications may occur. Cardiac tamponade, resulting from catheter malposition or delayed migration with perforation of the superior vena cava (SVC) or cardiac wall, is one such complication. This case highlights the need for vigilant monitoring even when initial catheter placement is confirmed as correct. Clinical Findings: A male infant born at 32 weeks' gestation with intrauterine growth restriction (IUGR) required mechanical ventilation and surfactant therapy. A PICC was inserted through the right radial vein, and radiographic assessment confirmed appropriate positioning in the SVC. The infant initially improved. On day 10 of NICU admission, he developed sudden respiratory distress, hypotonia, bradycardia, and cardiovascular collapse. Diagnosis: Echocardiography demonstrated severe pericardial effusion and cardiac tamponade due to SVC perforation by the PICC tip. Intervention and Outcome: The catheter was immediately removed, and emergency pericardiocentesis was performed. Despite aggressive resuscitation, the infant died on day 11 of life. Practice Recommendations: Delayed perforation can occur days after apparently correct placement. Preventive strategies should include risk-stratified catheter positioning, preference for lower SVC tip placement, routine echocardiographic surveillance especially after the first week and enhanced staff training for early recognition of warning signs. Continuous quality improvement and readiness for emergency intervention are essential to improve neonatal outcomes.