Migration patterns of peripherally inserted central venous catheters at 24 hours postinsertion in neonates
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Published on: July 13, 2019
Hari B Srinivasan1, Ansel Tjin-A-Tam, Rupernina Galang
1Department of Pediatrics, Mount Sinai Hospital, Chicago, Illinois.
Insights
Peripherally inserted central venous catheters (PICCs) in neonates frequently migrate, with 47% of upper limb PICCs shifting position within 24 hours. Over a third of these migrated PICCs moved toward the heart, necessitating further monitoring.
Area of Science:
- Neonatal intensive care
- Pediatric vascular access
- Medical device migration
Background:
- Peripherally inserted central venous catheters (PICCs) are crucial for neonatal care.
- Catheter migration is a known complication, particularly with upper limb positioning.
- Understanding migration patterns is vital for patient safety.
Purpose of the Study:
- To document the migration pattern of PICCs in neonates at 24 hours postinsertion.
- To analyze migration based on limb of insertion (upper vs. lower) and specific veins.
- To control for the influence of upper limb position on PICC migration.
Main Methods:
- Prospective study of 100 consecutively placed PICCs in a level III NICU.
- PICCs inserted in upper or lower limbs by certified nurses.
- Radiographic assessment immediately postinsertion and at 24 hours.
Main Results:
- 47% of upper limb PICCs migrated within 24 hours.
- 32.6% of migrated upper limb PICCs moved toward the heart.
- No migration observed in PICCs placed in saphenous veins (lower limb).
Conclusions:
- PICC migration is common in neonates, even when controlling for arm position.
- A follow-up X-ray at 24 hours is recommended for upper limb PICCs.
- This monitoring can help prevent complications associated with misplaced catheters.
Objective:
Migration of peripherally inserted central venous catheters (PICCs) is known to happen in neonates with changes in position of the upper limb. The aim of this study is to document the migration pattern of PICCs at 24 hours postinsertion, while controlling for arm position.
Study Design:
This was a single-centered prospective study of 100 consecutively placed PICCs in a level III neonatal intensive care unit (NICU). All PICCs were inserted by one of two certified NICU nurses in either upper or lower limb. An X-ray was obtained immediately after insertion and again at 24 hours postinsertion; both were reviewed by a single pediatric radiologist.
Results:
Of the PICCs placed in basilic veins, 35.5% migrated toward the heart, 14.5% migrated away from the heart, and 50% did not change in position. Of the PICCs placed in cephalic veins, 21% migrated toward the heart, 15.7% migrated away from the heart, and 63.3% did not change in position. None of the PICCs placed in the saphenous veins migrated.
Conclusion:
After controlling for arm position, 47% of PICCs placed in the upper limb migrated at 24 hours postinsertion with 32.6% migrating toward the heart. We recommend a follow-up X-ray at 24 hours postinsertion for all catheters placed in the upper limb.
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