(6) Identification of Clinical Characteristics Associated with PICC Complications in Hospitalized Infants in a Level IV NICU

Background: Central venous access is necessary for patients in the newborn intensive care unit (NICU). Peripherally inserted central catheters (PICCs) are commonly used to provide reliable long-term access for parenteral nutrition (PN), intravenous medications, blood product transfusions, and blood sampling. Despite their widespread use, nearly one-third of PICCs in infants are associated with complications that often necessitate unplanned removal and interrupt ongoing therapy. Known risk factors for these complications include catheter tip position and insertion site by extremity. Previous studies have focused on specific complications, such as line-associated thrombosis and infection, along with their related risk factors. However, the impact of PICC characteristics (e.g., size and number of lumens) and infant characteristics (e.g., weight and illness severity) on the risk of catheter-related complications has not been comprehensively studied in a large neonatal population.

Objectives: To identify infant and catheter characteristics associated with PICC-related complications in hospitalized infants.

Design/Methods: We performed a retrospective chart review of the electronic health record of infants hospitalized in a level IV NICU within a quaternary children’s hospital. Inclusion criteria included infants under 12 months of age at the time of admission, hospitalization in the NICU between January 2021- December 2023, and successful PICC placement by the NICU PICC team or interventional radiology. Infants who were transferred from an outside hospital with a pre-existing PICC had PICC encounters which were excluded. Of the infants assessed for eligibility, 778 were included in the study for a total of 1191 unique PICC line encounters. We utilized DataDirect and Electronic Medical Records Search Engine (EMERSE) software along with manual chart review to obtain data. Infant-specific data included gestational age, birth weight, admission diagnosis, weight at insertion, and NICU length of stay. PICC-specific data included indication, size, lumens, insertion site, duration, insertion team, use of PN or transfusions, and removal reason. Univariate analysis and multinomial logistic regression were used to assess clinical characteristics and potential associations with PICC-related complications.

Results:

Conclusions: