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Effects of two securement methods on peripherally inserted central catheter stability and skin integrity in very low
Xin Liu1, Fuqiang Sun1, Na Tang1
1Department of Neonatology, Second Hospital of Tianjin Medical University, Tianjin, China.
Insights
A new method for securing peripherally inserted central catheters (PICCs) significantly reduces dislodgement and skin injury in very low birth weight infants (VLBWIs). This improved securement strategy also lowers costs, making it ideal for neonatal intensive care units.
Area of Science:
- Neonatal Intensive Care
- Medical Device Securement
- Pediatric Vascular Access
Background:
- Very low birth weight infants (VLBWIs) frequently require peripherally inserted central catheters (PICCs) for extended venous access.
- Conventional securement techniques often lead to high rates of catheter dislodgement and associated skin injuries.
- The clinical and economic effectiveness of modified securement methods for PICCs in VLBWIs needs further validation.
Purpose of the Study:
- To evaluate the impact of a novel combination securement method on PICC dislodgement and skin injury rates in VLBWIs.
- To conduct a cost-effectiveness analysis comparing the novel method with conventional techniques.
- To provide evidence for selecting the optimal PICC securement strategy in neonatal settings.
Main Methods:
- Retrospective analysis of 181 VLBWIs undergoing PICC placement in a neonatal intensive care unit (NICU).
- Comparison between a conventional securement group and a modified group using a four-step technique (protection-pressure reduction-fixation-sealing).
- Propensity score matching (1:1 nearest-neighbor) was employed to balance baseline characteristics; clinical outcomes and costs were analyzed.
Main Results:
- The modified securement group demonstrated significantly lower rates of unplanned PICC removal (P=0.02) and skin injury (P<0.001) compared to the conventional group.
- The modified method was identified as an independent protective factor against unplanned PICC removal (OR=0.275, P=0.005).
- Total direct medical costs per PICC placement were significantly reduced in the modified group (P<0.001).
Conclusions:
- The modified combination securement method offers significant clinical benefits by improving outcomes and reducing complications related to PICC placement in VLBWIs.
- This approach demonstrates substantial cost savings, contributing to overall economic efficiency in the NICU.
- The enhanced clinical efficacy and cost-effectiveness suggest that this modified securement method should be widely adopted in neonatal care settings.
Background:
Very low birth weight infants often require peripherally inserted central catheter (PICC) for long-term venous access. Conventional securement methods are associated with high rates of catheter dislodgement and skin injury, but the clinical effectiveness and cost-effectiveness of modified combination securement methods remain insufficiently validated. This study aimed to investigate the effects of a novel combination securement method on catheter dislodgement and skin injury in very low birth weight infants (VLBWIs) undergoing PICC placement, and to perform a cost-effectiveness analysis to inform evidence-based selection of the optimal securement strategy.
Methods:
This retrospective, single-center analysis comprised 181 VLBWIs who underwent PICC placement in the neonatal intensive care unit (NICU) between January 2018 and December 2025. Infants were assigned to either a conventional securement group (conventional group) or a modified combination fixation group (modified group), the latter consisting of four steps: pressure relief protection, tension-free fixation, buffer reinforcement, and sealing coverage (termed 'protection-pressure reduction-fixation-sealing'). A 1:1 nearest-neighbor propensity score matching (PSM) approach was used to balance baseline confounders. After matching, clinical outcomes and direct medical costs were compared between groups, and correlations between cost metrics and clinical outcomes were analyzed.
Results:
Following matching, baseline characteristics were well balanced between groups, with no significant differences (all P>0.05). The modified group showed significantly lower rates of unplanned PICC removal and skin injury than the conventional group (P=0.02 and P<0.001, respectively). Logistic regression identified the modified securement method as an independent protective factor against unplanned PICC removal in VLBWIs [odds ratio (OR) =0.275, P=0.005]. Moreover, total direct medical cost per PICC placement was significantly lower in the modified group (P<0.001).
Conclusions:
The modified combination securement method significantly improves clinical outcomes associated with PICC placement in VLBWIs, reduces complication rates, and achieves overall cost savings. Offering both clinical and economic benefits, this approach warrants widespread adoption in the NICU.
