Peripherally Inserted Central Catheter Tip Malposition in Neonates: A Comparison of Placement in the Head & Neck, Upper Extremity, and Lower Extremity

Background: While catheter lengths are determined based on guidelines, regional studies should be considered to ensure optimal catheter placement. Objectives: This study aimed to compare the incidence of tip malposition and the amount of catheter retraction required to achieve appropriate placement in peripherally inserted central catheters (PICC) inserted in the head and neck, upper extremities, and lower extremities to determine the optimal catheter placement site. Methods: This cross-sectional study was conducted in the Children's Medical Center NICU between 2020 and 2021. After the initial calculation of catheter insertion length based on guidelines, PICC placement was performed by two skilled nurses. The catheter position was then confirmed, and the amount of catheter retraction was compared for each group. Results: A total of 368 neonates were included in the study. The results showed a statistically significant higher incidence of catheter tip malposition in the upper extremity group (P-value = 0.004). The minimum amount of catheter retraction required to achieve proper placement was 1 cm. Conclusions: This study suggests that the formula for calculating the length of the catheter in the upper extremities should be adjusted. However, further studies are needed to confirm this.