Difficult catheter advancement in neonatal PICC insertion
Abstract:
Neonatal peripherally inserted central catheters (n-PICCs) are vital for long-term vascular access in neonates. However, difficult catheter advancement (DCA), which is a frequent procedural complication, remains poorly studied, with limited evidence regarding its incidence and risk factors in this population. A prospective multicenter observational study was conducted across five hospitals in Shaanxi, China (May 2024-May 2025). We enrolled 276 neonates who needed n-PICC placement. Data on demographic characteristics, procedural details, and outcome variables were collected. Moreover, multivariate logistic regression was used to identify factors associated with DCA. The incidence of DCA was 21.01%. Age in days at n-PICC insertion (OR = 1.082; P < 0.001), a weight of less than 1000 g at n-PICC positioning (OR = 10.263; P = 0.001), and lower-limb insertion (OR = 4.316; P = 0.010) were independent risk factors, whereas intraprocedural ultrasound utilization (OR = 0.096; P < 0.001) and first-attempt puncture success (OR = 0.277; P = 0.001) were protective factors.
Conclusion: DCA is common during neonatal PICC insertion. Independent risk factors include later insertion timing, very low procedural weight (< 1000 g), and lower-limb insertion. Additionally, the use of intraprocedural ultrasound and first-attempt puncture success is a protective factor. These findings underscore the importance of using ultrasound guidance and techniques to improve first-attempt success, especially for high-risk infants, to enhance procedural safety and efficacy.
What is known: DCA contributes to neonatal PICC failure and causes complications but is often not distinguished from puncture failure in studies. In many Chinese settings, only 1.9Fr catheters are available.
What is new: DCA occurred in 21.01% of neonatal PICC insertions; Late insertion, weight < 1000 g at insertion, and lower-limb sites were independent risk factors, while intraprocedural ultrasound and first‑attempt puncture success were protective factors. This is the first study to systematically quantify DCA and its determinants in neonates, offering direct clinical guidance.
Reference:
Wei H, Wang Q, Jiang X, Wu T, Lin Y, Tong H, Yang A, Cheng G, Liu Y, Ren B, Liu D, Xie X. Current status of and factors influencing difficult catheter advancement in neonatal PICC insertion: a prospective multicenter observational study. Eur J Pediatr. 2026 Apr 6;185(5):238. doi: 10.1007/s00431-026-06867-w. PMID: 41941001.