Reducing Peripherally Inserted Central Catheter Tip Migration in Neonates: A Proactive Approach to Detection and Repositioning

<b>Objective</b>: Peripherally Inserted Central Catheter (PICC) tip migration often occurs after placement despite efforts to position the tip centrally. This study aimed to quantify PICC tip migration within 3-7 h post-insertion and evaluate the effectiveness of manual adjustments for repositioning. <b>Methods</b>: This single-centre retrospective study evaluated the impact of a proactive approach following PICC placement, which included standardized body positioning during X-rays, defined target PICC tip locations, radiological surveillance at 4-6 h post-insertion, and guided manual adjustments. We included all infants receiving PICCs during a five-year period; trained nurses and physicians in vascular access performed the insertions. <b>Results</b>: Of 712 infants included, the median gestational age was 30 weeks, and the median birth weight was 1386 g. PICC tip migration occurred in 211 infants (30%) within 3-7 h post-insertion, with 81% of cases involving inward migration into the cardiac silhouette. Migration was more common in upper limb PICCs (82%). Manual adjustments achieved satisfactory repositioning in 191 infants (83%). None of the infants experienced pericardial effusion. <b>Conclusions</b>: A proactive approach that standardized imaging protocols, timing, and PICC tip positioning detected migration in 30% of infants and successfully facilitated repositioning in 83% of cases.