Neonatal PICC-related complications: Risk factors and evaluation of an optimized nursing care pathway in a retrospective cohort study

Peripherally inserted central catheters (PICCs) are commonly used for long-term intravenous therapy in neonates, but catheter-related complications remain a concern that may affect treatment safety. Data on risk factors and nursing interventions in neonatal PICC care are limited. This retrospective cohort included 309 neonates who received PICCs between January 2023 and May 2025. We performed a cohort-wide risk factor analysis and a pre-post evaluation of an optimized nursing pathway implemented in April 2024, with groups defined by placement date. For outcome ascertainment, records were reviewed through 24 to 48 hours after catheter removal. Time to first PICC-related complication was analyzed using Kaplan-Meier curves and multivariable Cox regression. Kaplan-Meier curves showed shorter complication-free catheter survival in extremely preterm infants (<28 weeks + 0 days), female neonates, those with ≥4 puncture attempts, and those with nonideal catheter tip positions (log-rank P < .05 for each comparison). In multivariable Cox regression, female sex (adjusted hazard ratio [aHR] = 1.87, 95% confidence interval [CI] = 1.21-3.18; P = .015) and nonideal tip position (aHR = 3.01, 95% CI = 1.37-6.59; P = .006) remained independently associated with higher complication risk; single-attempt placement showed borderline lower risk than ≥4 attempts (aHR = 0.58, 95% CI = 0.33-1.01; P = .053). The Standard group had higher complication risk than the Optimized group (hazard ratio = 3.41, 95% CI = 2.15-5.41; aHR = 3.50, 95% CI = 2.16-5.67; both P < .001), with the largest difference within 14 days after insertion; cumulative incidence of any complication was 37.0% versus 19.6% (risk ratio = 1.88, 95% CI = 1.29-2.74). Prematurity, female sex, nonideal catheter tip position, and higher puncture attempts were associated with an increased risk of PICC-related complications. The optimized nursing management pathway was associated with improved complication-free catheter survival and reduced complications in neonatal PICC care.