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Neonatal PICC-related complications: Risk factors and evaluation of an optimized nursing care pathway in a
Xuan Zhou1, Qingqing Du, Ying Xia
1Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China.
Insights
Peripherally inserted central catheters (PICCs) in neonates have risks. Female sex, nonideal tip position, and multiple insertion attempts increase complications. An optimized nursing pathway significantly reduced these risks.
Area of Science:
- Neonatal intensive care
- Vascular access devices
- Pediatric nursing
Background:
- Peripherally inserted central catheters (PICCs) are vital for neonatal long-term intravenous therapy.
- Catheter-related complications pose significant risks to treatment safety in neonates.
- Limited data exists on risk factors and effective nursing interventions for neonatal PICC care.
Purpose of the Study:
- To identify risk factors associated with PICC-related complications in neonates.
- To evaluate the effectiveness of an optimized nursing pathway in reducing these complications.
- To improve complication-free catheter survival rates in neonatal populations.
Main Methods:
- Retrospective cohort study of 309 neonates receiving PICCs (January 2023 - May 2025).
- Risk factor analysis and pre-post evaluation of an optimized nursing pathway implemented in April 2024.
- Kaplan-Meier curves and multivariable Cox regression analyzed time to first PICC-related complication.
Main Results:
- Extremely preterm infants, female neonates, ≥4 puncture attempts, and nonideal catheter tip positions were linked to shorter complication-free survival.
- Female sex (aHR=1.87) and nonideal tip position (aHR=3.01) were independent risk factors for complications.
- The optimized nursing pathway group showed significantly lower complication risk (aHR=3.50) compared to the standard group (cumulative incidence 19.6% vs 37.0%).
Conclusions:
- Prematurity, female sex, nonideal catheter tip position, and multiple puncture attempts are significant risk factors for neonatal PICC complications.
- The implemented optimized nursing management pathway demonstrated a marked improvement in complication-free catheter survival.
- This optimized pathway effectively reduces the incidence of complications in neonatal PICC care, enhancing patient safety.
Abstract:
Peripherally inserted central catheters (PICCs) are commonly used for long-term intravenous therapy in neonates, but catheter-related complications remain a concern that may affect treatment safety. Data on risk factors and nursing interventions in neonatal PICC care are limited. This retrospective cohort included 309 neonates who received PICCs between January 2023 and May 2025. We performed a cohort-wide risk factor analysis and a pre-post evaluation of an optimized nursing pathway implemented in April 2024, with groups defined by placement date. For outcome ascertainment, records were reviewed through 24 to 48 hours after catheter removal. Time to first PICC-related complication was analyzed using Kaplan-Meier curves and multivariable Cox regression. Kaplan-Meier curves showed shorter complication-free catheter survival in extremely preterm infants (<28 weeks + 0 days), female neonates, those with ≥4 puncture attempts, and those with nonideal catheter tip positions (log-rank P < .05 for each comparison). In multivariable Cox regression, female sex (adjusted hazard ratio [aHR] = 1.87, 95% confidence interval [CI] = 1.21-3.18; P = .015) and nonideal tip position (aHR = 3.01, 95% CI = 1.37-6.59; P = .006) remained independently associated with higher complication risk; single-attempt placement showed borderline lower risk than ≥4 attempts (aHR = 0.58, 95% CI = 0.33-1.01; P = .053). The Standard group had higher complication risk than the Optimized group (hazard ratio = 3.41, 95% CI = 2.15-5.41; aHR = 3.50, 95% CI = 2.16-5.67; both P < .001), with the largest difference within 14 days after insertion; cumulative incidence of any complication was 37.0% versus 19.6% (risk ratio = 1.88, 95% CI = 1.29-2.74). Prematurity, female sex, nonideal catheter tip position, and higher puncture attempts were associated with an increased risk of PICC-related complications. The optimized nursing management pathway was associated with improved complication-free catheter survival and reduced complications in neonatal PICC care.
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