A knotted problem.

Arch Dis Child January 2011 Vol 96 No 1 An 8-year-old boy with cystic fi brosis was planned for a course of home intravenous antibiotics. A peripherally inserted central catheter (PICC) was inserted from his left wrist on the third attempt. By the third day, he had developed a swollen red forearm. Clinically, a small non-tender nodule was palpable 1 cm proximal to a healthy insertion site. The line could not be removed with gentle traction. The line was assessed by x-ray, which showed knotting of the PICC line in the region of the palpable nodule (fi gure 1). Under general anaesthesia, venotomy was performed to remove the knotted long line (fi gure 2) and a portacath inserted. The knot was intraluminal. Knotting in PICC lines is an important cause of diffi cult PICC line removal. Failure to recognise this and forceful removal can result in venous trauma, line fracture and embolisation.