Complications and risk factors of neonatal peripherally inserted central catheters lines

BACKGROUND: Peripherally inserted central catheters (PICCs) are widely used in neonatal intensive care units (NICUs) but are associated with a broad spectrum of complications. Evidence regarding their incidence and risk factors in neonates remains limited. METHODS: We conducted a retrospective cohort study including 1800 neonates who underwent PICC placement between 2018 and 2025, accounting for 24,660 catheter-days. Mechanical, infectious, thrombotic, and other PICC-related complications were systematically recorded. Incidence densities were calculated per 1000 catheter-days. Multivariable logistic regression was used to identify independent predictors of catheter-related bloodstream infection (CRBSI) and non-technical complications. RESULTS: At least one PICC-related complication occurred in 58.2% of neonates (41.8 per 1000 catheter-days). Catheter tip malposition was the most frequent event (47.8%), followed by occlusion or edema (18.3%) and migration or dislodgement (12.2%). CRBSI occurred in 6.2% of infants, with an incidence of 4.3 per 1000 catheter-days. Cephalic vein insertion was strongly associated with malposition (adjusted odds ratio [aOR] 7.30; 95% CI 5.90-9.02). Prolonged catheter dwell time independently increased the risk of CRBSI (aOR 1.10 per day; p < 0.001), while total parenteral nutrition and intravenous anticonvulsant therapy were additional independent predictors. Non-technical complications were independently associated with lower birth weight, catheter malposition, hyperosmolar medication exposure, and longer dwell time. CONCLUSIONS: PICC-related complications are common in neonates, with malposition representing the predominant event and associated with subsequent adverse outcomes. Optimizing insertion site selection, minimizing catheter dwell time, and cautious use of hyperosmolar infusions may reduce PICC-related morbidity in the NICU.