Objective To develop a risk prediction model for secondary malposition of peripherally inserted central catheters (PICC) in very low birth weight (VLBW) infants, and to provide a reference for identifying risk factors and implementing early targeted interventions. Methods A total of 312 VLBW infants who had a PICC in the neonatal intensive care unit were recruited.Baseline data and PICC-specific data were retrospectively collected.Univariate and logistic regression analysis were performed to identify risk factors, then a nomogram was generated. Results The incidence of secondary malposition of PICC in VLBW infants was 18.59%.Risk factors for catheter malposition included:duration of non-invasive ventilation （OR=1.022）, average daily duration of prone position ventilation （OR=1.182）, PICC-related phlebitis （OR=2.509）, and insertion site （OR=4.352）.The area under the Receiver Operating Characteristic curve of the developed risk prediction model was 0.705 （95%CI:0.628-0.782）. Conclusion VLBW infants have a relatively high risk of secondary malposition of PICC.The nomogram risk prediction model demonstrates certain predictive value and can serve as a tool for healthcare professionals to identify infants at high-risk.