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Background: - Thrombi are common complication of long line like umbilical venous catheter or peripherally inserted central catheter (PICC) mainly in extreme and very preterm baby but there is no well-formed protocol for its treatment in pediatrics age group especially in Neonates. There are still very less cases are reported. Case Presentation: - Male DCDA twin 2 with birth weight of 750 gram had secondary deterioration on day 21 of life with recurrent apnea poor perfusion and increased oxygen requirement. Echo showed a large thrombus in right atrium which was successfully treated with infusion of unfractionated Heparin followed by subcutaneous low molecular weight Heparin. Conclusion: - Right atrial thrombus is a common complication of central line mainly in preterm baby and Heparin gives good result without any complications if baby is hemodynamically stable and urgent thrombolysis in not required.