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Peripherally Inserted Central Catheter Complications in Neonates With Upper Versus Lower Extremity Insertion Sites

Wrightson, Della Daugherty MSN, RNC-NIC

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0b013e31827e1d01
Original Research

PURPOSE: To compare peripherally inserted central catheter (PICC) complication rates in upper versus lower extremity insertion sites in neonates.

SUBJECTS: Neonates who had PICCs inserted while hospitalized in an urban, 84-bed, level III neonatal intensive care unit in the southwestern United States between 2004 and 2009 were included in the study. A total of 559 neonates with 626 PICCs were reviewed. Neonates who were transferred out of the hospital with an indwelling PICC or had incomplete PICC data were excluded (n = 29).

DESIGN: Comparative descriptive.

METHOD: Retrospective review of PICC records. Demographic data, neonate survival to PICC removal, PICCs inserted by non-PICC team members, and complications were compiled. Complications included presumed sepsis, occlusion, leaking, infiltration/edema, inadvertent removal, phlebitis, pleural effusion, tip malposition, and catheter breakage. The complications were analyzed between extremities using chi-square or independent-samples t test where appropriate.

MAIN OUTCOME MEASURES: Type and rate of complication requiring PICC removal and the extremity used for insertion.

PRINCIPAL RESULTS: A total of 374 PICCs (59.7%) were inserted in upper extremities and 252 (40.3%) in lower extremities. The upper and lower extremity groups were comparable in all variables except neonate survival to PICC removal, which was greater in neonates with lower extremity PICCs (95.2% in upper extremities vs 98.8% in lower extremities; P = .01). No significant difference (P = .08) was found in the overall complication rate (27% in upper extremity PICCs vs 21% in lower extremity PICCs). Presumed sepsis was the most common complication requiring PICC removal in both extremity groups. At the time of removal, upper extremity PICCs were more likely to have a noncentral tip than lower extremity PICCs (15% vs 4%, respectively). In PICCs removed because of complications, noncentral tips were found to be statistically significant in upper extremity PICCs (P < .0001).

CONCLUSIONS: No significant difference was found in complications that necessitated PICC removal between upper versus lower extremity PICC insertion sites. Catheter tip location may have a significant impact on complications and deserves further investigation. The choice of a PICC insertion site in neonates should be based on the quality of appropriate, available veins and the preference and skill of the inserter. Every effort should be made to achieve and maintain a centrally located PICC tip.

Neonatal Intensive Care and Progressive Care Nurseries, Levine Children's Hospital, Charlotte, North Carolina.

Correspondence: Della Daugherty Wrightson, MSN, RNC-NIC, Levine Children's Hospital, PO Box 32861, Office 7320, 7th Floor CMC, Charlotte, NC 28232 (

The study was conducted at Texas Health Presbyterian Hospital Dallas, Neonatal Intensive Care Nursery, Texas.

The author thanks the Texas Health Presbyterian Hospital Dallas NICU PICC team; Elizabeth Winslow, PhD, RN, FAAN; Gerald Nystrom, MD; Sharon Williamson, MT (ASCP) SM, CIC; and Sejong Bae, PhD, for their invaluable assistance in preparing this manuscript.

The author declares no conflict of interest.

© 2013 by The National Association of Neonatal Nurses