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Evaluation of Neonatal Peripherally Inserted Central Catheter Tip Movement in a Consistent Upper Extremity Position

Newberry, Desi M. DNP, NNP-BC; Young, Thomas E. MD; Robertson, Tracey DNP, NNP-BC, RNC; Levy, Janet PhD; Brandon, Debra PhD, RN, CCNS, FAAN

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000036
Original Research

OBJECTIVE: To compare the effect of standardized upper extremity position versus varied upper extremity positions on neonatal peripherally inserted central catheter (PICC) tip placement and movement. Secondary outcomes assessed were compliance with education, implementation, and complication rates.

STUDY DESIGN: Tip movement was analyzed between 136 post-PICC insertion x-ray pairs from 72 infants in the 6 months before and after standardization of upper extremity position. Tip movement was regressed over days between x-ray pairs, respiratory support, absolute weight change, and insertion vein.

RESULTS: There was no difference in PICC tip movement among varied analysis pairs or when standard position pairs were compared with pairs that were in a same nonstandard position. Days between x-rays, respiratory support, absolute weight change, and insertion vein did not predict tip movement. Attendance at education sessions was 100%. Compliance with the new standard was 73%. Complication rates were not significantly different.

CONCLUSION: Standardization of upper extremity position during neonatal PICC confirmation x-rays did not alter PICC tip movement.

Duke University School of Nursing, Durham, and WakeMed Faculty Physicians–Neonatology, Raleigh, North Carolina (Drs Newberry and Robertson); WakeMed Faculty Physicians–Neonatology, Raleigh, North Carolina, and University of North Carolina–Chapel Hill (Dr Young); and Duke University School of Nursing (Drs Levy and Brandon) and Department of Pediatrics, Duke University School of Medicine (Dr Brandon), Durham, North Carolina.

Correspondence: Desi M. Newberry, DNP, NNP-BC, 120 Tiercel Ct, Cary, NC 27518 (

The authors thank Julie Thompson for her statistical support.

The authors declare no conflict of interest.

© 2014 by The National Association of Neonatal Nurses