Pediatric Radiology

, Volume 47, Issue 12, pp 1676–1681 | Cite as

Non-central peripherally inserted central catheters in neonatal intensive care: complication rates and longevity of catheters relative to tip position

  • Bernard Goldwasser
  • Catalina Baia
  • Mimi Kim
  • Benjamin H. Taragin
  • Robert M. Angert
Original Article

Abstract

Background

Peripherally inserted central catheters (PICCs) represent a mainstay of intravascular access in the neonatal intensive care setting when long-term vascular access is needed. Ideally, PICCs should be inserted and maintained in a central position with the tip ending in the superior or inferior vena cava. This is not always achievable, and sometimes the tip remains in a peripheral location. Higher complication rates have been reported with non-central PICCs; however these findings have not been confirmed in a solely neonatal series and PICCs with tips in peripheral veins have not been studied.

Objective

To compare complication rates and length of catheter duration related to PICC position in neonates.

Materials and methods

We conducted a retrospective analysis of all PICCs inserted in term and preterm infants in a tertiary neonatal intensive care unit between May 2007 and December 2009. A single pediatric radiologist reinterpreted the catheter tip site on initial anteroposterior (AP) chest radiographs and categorized sites as central (superior vena cava, inferior vena cava, brachiocephalic vein), intermediate (subclavian, axillary, common or external iliac veins), or peripheral (veins peripheral to axillary or external iliac veins). We analyzed complication rates and length of catheter duration among the three categories.

Results

We collected data on a total of 176 PICCs. Infants with PICCs in a central location had a significantly lower complication rate (18/97, 19%) than those with the PICC tip in an intermediate (24/64, 38%) or peripheral (9/15, 60%) locations (P=0.0003). Length of catheter duration was noted to be longest with central, intermediate with intermediate, and shortest with peripheral PICC tip locations (17.7±14.8 days for central vs. 11.4±10.7 days for intermediate vs. 5.4±2.5 days for peripheral, P=0.0003).

Conclusion

A central location is ideal for the tip of a PICC. When this is not achievable, an intermediate location is preferable to a more peripheral position.

Keywords

Chest radiography Intravascular access Neonatal intensive care unit Neonates Peripherally inserted central catheter 

Notes

Compliance with ethical standards

Conflicts of interest None

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of RadiologyJacobi Medical Center/Albert Einstein College of MedicineBronxUSA
  2. 2.Department of NeonatologySheridan Healthcare of TexasSouthlakeUSA
  3. 3.Department of Epidemiology & PopulationAlbert Einstein College of MedicineBronxUSA
  4. 4.Departments of Pediatrics and RadiologyAlbert Einstein College of MedicineBronxUSA
  5. 5.Department of RadiologyMontefiore Medical CenterBronxUSA
  6. 6.Division of Neonatology, Department of PediatricsMontefiore Medical Center, Albert Einstein College of MedicineBronxUSA

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