Peripherally inserted central catheter tip position and risk of associated complications in neonates

To characterize the relationship between peripherally inserted central catheters (PICC) tip positions and associated complications in neonates.

Catheter tip position for 319 infants was classified into superior vena cava (SVC, n=131), inferior vena cava (IVC, n=72), brachiocephalic (BC, n=59), midclavicular (MC, n=49) or iliac. Duration of catheter stay and complication profile was compared between central (SVC/IVC) vs non-central PICC, and between SVC vs IVC, SVC vs BC and SVC vs MC. Kaplan-Meier survival analysis and regression models were used.

Overall length of catheter stay was similar between central and non-central group. Non-central catheters (n=116) had higher complication rates (47 vs 29%; P=0.001), non-elective removals (45 vs 27%; P=0.002) and shorter time to complication (6.2 vs 11.4 days; P=0.043). This difference was primarily due to the complications encountered in MC group, which had the highest rate of infiltration (P<0.001) and mechanical complications while outcomes were similar among other subgroups. Interestingly, catheter survival probability was similar in all groups for first 4 days. Rate and types of blood stream infections were not related to catheter tip position.

Non-central PICCs are associated with higher rates of infiltration and mechanical complications when the tip is in MC region. BC catheters may have comparable outcomes to SVC in neonates. A careful risk-benefit analysis is warranted when MC catheters are used in neonates.