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

Objective:to characterize the relationship between peripherally inserted central catheters (picc) tip positions and associated complications in neonates.study design: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.result: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.conclusion: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.