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Peripherally inserted central catheters are frequently used for durable central venous access for nutrition. Depending on the medical and surgical history, there are times when a person’s vasculature has become scarred or stenotic due to multiple previous vascular devices, catheters, or pacemaker/defibrillator leads, that causes placement of a peripherally inserted central catheter challenging. Choosing the correct catheter and approach must be weighed against invasiveness of the procedure as unforeseen complications can arise. When pleural effusions quickly accumulate after placement of a peripherally inserted central catheter despite using confirmatory image guidance, delayed complications must be thought of, and offending medications and catheter should be removed in a timely fashion to avoid further morbidity and mortality.