I've been managing a term severe IUGR infant of 760g for the past two days and noticed recently that the lleg where a PICC line was placed the night before is slightly swollen. Unfortunately a 24gauge PICC was inserted. The leg is swollen mainly from the knee down to the foot unilateral, with only slight compacticity in the isolateral thigh, with no redness or increased temp. The opinion of the PICC team is that this is cause by obstruction of the venous flow and close monitoring should be suficient for now. I am concerned about the development of DVT!

1- Have you seen this associated edema in an extemity with a PICC line due to vein flow stasis?

1- Will you monitor these babies clinically without pulling the PICC out if no worsenng, severe or associated with compromised perfussion?

Thanks for your experinced advice

Difficult question, a DVT is not something we would normally consider, and the explanation seems reasonable.

If there are no other signs of inflammation or pain, we would probably wait and see BUT look for worsening very carefully, and remove the PICC on "liberal" indications.

We would probably try to position the leg (in comfortable positions) to see if that would reduce the swelling too.

Thanks for the feedback Stephan. I did place the leg in comfortable semi-elevated position and the swelling went away

Cheers