Iranian Journal of Neonatology

Iranian Journal of Neonatology

The Complications Caused by Peripherally Inserted Central Catheters and Related Risk Factors in Preterm Infants Admitted to the NICU

Document Type : Original Article

Authors
Seyed Reza Mirjalili 1
Atena Dadgari 2
Imane Bagheri 3
Zahra Ghafarian 1
Fatemeh Nazari 1
Naiire Salmani 1
1 Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Nursing Faculty, Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Nursing Faculty, Nursing and Midwifery School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
10.22038/ijn.2025.82465.2589
Abstract
Background: Central venous catheter placement through a peripheral vein is considered a valuable care strategy for infants with low and very low birth weight but it can be associated with complications. This study aimed to determine the incidence of complications arising from central venous catheter placement through peripheral veins in premature infants admitted to the neonatal intensive care unit (NICU) and to identify related risk factors.
Methods: This cross-sectional study was conducted on 323 premature infants with central venous catheters placed through peripheral veins who were admitted to the NICU of Shahid Sadoughi Educational Hospital in Yazd. Data were collected from March 2021 to March 2024 through the completion of a checklist assessing the catheter placement site by the nurse responsible for caring for infants during each shift. parametric and non parametric data analysis using SPSS software version 16.
Results: The mean gestational age and birth weight were 30.7 ± 2.83 weeks and 1391.63 ± 467.47 grams, respectively. Besides, 27.2% of the premature infants with catheters experienced complications. The most common complications in order of frequency were phlebitis (6.2%), catheter occlusion (4%), and leakage of secretions (4%), while bloodstream infection had the lowest occurrence rate (0.9%). In the univariate logistic regression model, the likelihood of complications increased by 1.02 times for each additional day of NICU stay and was 4.6 times higher with improper catheter positioning.
Conclusion: Continuous monitoring of the catheter insertion site for the occurrence of visible complications and the catheter's positioning should be prioritized in care. Moreover, the number of days of hospitalization could be reduced by improving the quality of treatment processes and nursing care.
Keywords
Catheter-related complication
Factors
Neonatal intensive care unit
Peripherally inserted central catheters
Preterm infants
  1. Hosseini SS, Baniasadi H, Pouraboli B. Stressors of parents of hospitalized preterm infants: a study in neonatal intensive care unit of Afzalipour Hospital, Kerman, Iran. J Public Hlth Dev. 2015;4(4):337-3
  2. Hasanpour S, Ouladsahebmadarek E, Hosseini MB, Mirghafourvand M, Heidarabadi S, Jafarabadi MA. Mother-infant attachment at the age of 1 year in recipients of developmental care after preterm birth. Int J Womens Health Reprod Sci. 2018;6(1):90-9
  3. Benzies KM, Magill-Evans JE, Hayden KA, Ballantyne M. Key components of early intervention programs for preterm infants and their parents: A systematic review and meta-analysis. BMC pregnancy and childbirth. 2013;13 Suppl 1:S10.
  4. Aftyka A, Rybojad B, Rosa W, Wrobel A, Karakula-Juchnowicz H. Risk factors for the development of post-traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit. J Clin Nurs. 2017;26(23-24):4436-44
  5. Liossis G, Bardin C, Papageorgiou A. Comparison of risks from percutaneous central venous catheters and peripheral lines in infants of extremely low birth weight: a cohort controlled study of infants <1000 g. J Matern Fetal Neonatal Med. 2003;13(3):171-174.
  6. Oelberg DG, Baker A, Quast D, Worley L. Impact of umbilical catheterization on morbidity and mortality in extremely premature newborns. J Neonatal Perinatal Med. 2014;7(1):13–9.
  7. Padilla-Sánchez C, Montejano-Lozoya R, Benavent-Taengua L, Monedero-Valero A, Borras-Vañó MJ, Ángel-Selfa MJ, et al. Risk factors associated with adverse events in neonates with peripherally inserted central catheter. Enfermería Intensiva (English ed.). 2019;30(4):170-180.
  8. van den Hoogen A, Brouwer MJ, Gerards LJ, Fleer A, Krediet TG. Removal of percutaneously inserted central venous catheters innneonates is associated with the occurrence of sepsis. Acta Paediatr. 2008;97(9):1250-1252.
  9. O'grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193.
  10. Gorski LA. Infusion nursing standards of practice. J Infus Nurs. 2007;30(3):151-152.
  11. Infusion Nurses Society. Infusion nursing standards of practice.J Infus Nurs. 2006;29(1 Suppl):S1-S92.
  12. Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics. 2013;132(6):e1609-1615.
  13. Li R, Cao X, Shi T, Xiong L. Application of peripherally inserted central catheters in critically ill newborns experience from a neonatal intensive care unit. Medicine. 2019;98(32):e15837.
  14. Colacchio K, Deng Y, Northrup V, Bizzarro MJ. Complications associated with central and non-central venous catheters in a neonatal intensive care unit.J Perinatol 2012;32(12):941–946.
  15. Westergaard B, Classen V, Walther-Larsen S. Peripherally inserted central catheters in infants and children-indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand. 2012;57(3):278-287.
  16. Fallouh N, McGuirk HM, Flanders SA, Chopra V. Peripherally inserted central catheter-associated deep vein thrombosis: a narrative review. Am J Med. 2015;128(7):722-738.
  17. Ohki Y, Yoshizawa Y, Watanabe M, Kuwashima M, Morikawa Complications of percutaneously inserted central venous catheters in Japanese neonates. Pediatr Int. 2008;50(5):636-639.
  18. Raju TN, Pemberton VL, Saigal S, Blaisdell CJ, Moxey-Mims M, Buist S. Long-term healthcare outcomes of preterm birth: an executive summary of a conference sponsored by the national institutes of health. J Pediatr 2017;181:309-318.
  19. Jain A, Deshpande P, Shah P. Peripherally inserted central catheter tip position and risk of associated complications in neonates. J Perinatol 2013;33(4):307–312.
  20. Costa P, Kimura AF, Brandon DH, Damiani LP. Predictors of nonelective removal of peripherally inserted central catheters in Biol Res Nurs. 2016;18(2):173–180.
  21. de Lima Jacinto AK, Avelar AF, Pedreira ML. Predisposing factors for infiltration in children submitted to peripheral venous catheterization. J Infus Nurs. 2011;34(6):391-398.
  22. Unbeck M, Förberg U, Ygge BM, Ehrenberg A, Petzold M, Johansson E. Peripheral venous catheter related complications are common among paediatric and neonatal patients. Acta Paediatrica. 2015;104(6):566-574.
  23. Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics. 2013;132(6):e1609-1615.
  24. Kisa P, Ting J, Callejas A, Osiovich H, Butterworth SA. Major thrombotic complications with lower limb PICCs in surgical neonates. J Pediatr Surg. 2015;50(5):786-789.
  25. Costa P, Paiva ED, Kimura AF, Castro TE. Risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates. Acta Paul Enferm. 2016 1;29:161-168.
  26. Elmekkawi A, Maulidi H, Mak W, Aziz A, Lee KS. Outcomes of upper extremity versus lower extremity placed peripherally inserted central catheters in a medical-surgical neonatal intensive care unit. J Neonatal Perinatal Med. 2019;12(1):57-63.
  27. Ozkiraz S, Gokmen Z, Ince DA, Akcan AB, Kilicdag H, Ozel D, et al. Peripherally inserted central venous catheters in critically ill premature neonates. J Vasc Access. 2013;14(4):320-324.
  28. Pet GC, Eickhoff JC, McNevin KE, Do J, McAdams RM. Risk factors for peripherally inserted central catheter complications in neonates. J Perinatol. 2020;40(4):581-588.
  29. Tomar RS, Gupta AK, Khan ID. Incidence of catheter-related bloodstream infections after removal of peripherally inserted central catheters in preterm neonates. Int J Contemp Pediatr. 2020;7(2):282-286.
  30. Yu X, Yue S, Wang M, Cao C, Liao Z, Ding Y, et al. Risk factors related to peripherally inserted central venous catheter nonselective removal in neonates. Biomed Res Int. 2018;2018(1):3769376.
  31. Padilla-Sánchez C, Montejano-Lozoya R, Benavent-Taengua L, Monedero-Valero A, Borras-Vañó MJ, Ángel-Selfa MJ, et al. Risk factors associated with adverse events in neonates with peripherally inserted central catheter. Enfermería Intensiva (English ed.). 2019;30(4):170-180.
  32. Bulbul A, Okan F, Nuhoglu A. Percutaneously inserted central catheters in the newborns: a center's experience in Turkey. J Matern Fetal Neonatal Med. 2010;23(6):529-535.
  33. Costa P, Kimura AF, Brandon DH, Paiva ED, Camargo PP. The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns. Rev Lat Am Enferm. 2015;23(3):475-482.
  34. Paiva ED, Kimura AF, Costa P, de Castro Magalhães TE, Toma E, Alves AM. Complications related to the type of epicutaneous catheter in a cohort of neonates. Online Braz J Nurs. 2013;12(4):942-952.
  35. Wu Y, Yan J, Tang M, Hu Y, Wan X, Li X, et al. A review of neonatal peripherally inserted central venous catheters in extremely or very low birthweight infants based on a 3-year clinical practice: complication incidences and risk factors. Front Pediatr. 2022;10:987512.
  36. Gavelli V, Wackernagel D. Peripherally inserted central catheters in extremely preterm infants: Placement success rates and complications. Acta Paediatrica. 2022;111(3):554-556.
  37. Cheong SM, Totsu S, Nakanishi H, Uchiyama A, Kusuda S. Outcomes of peripherally inserted double lumen central catheter in very low birth weight infants. J Neonatal-perinatal Med. 2016;9(1):99-105.
  38. Suliman M, Saleh W, Al-Shiekh H, Taan W, AlBashtawy M. The incidence of peripheral intravenous catheter phlebitis and risk factors among pediatric patients. J Pediatr Nurs. 2020; 50:89-93.
  39. Razavinejad SM, Saeed N, Pourarian S, Rezaei M, Bahrami R, Yazdani N, et al. Complications and related risk factors of peripherally inserted central catheters in neonates: a historical cohort study. Arch Iran Med. 2023;26(4):218.
  40. Pet GC, Eickhoff JC, McNevin KE, Do J, McAdams RM. Risk factors for peripherally inserted central catheter complications in neonates. J Perinatol. 2020;40(4):581-588.
  41. Padilla-Sánchez C, Montejano-Lozoya R, Benavent-Taengua L, Monedero-Valero A, Borras-Vañó MJ, Ángel-Selfa MJ, et al. Risk factors associated with adverse events in neonates with peripherally inserted central catheter. Enfermería Intensiva (English ed.). 2019;30(4):170-180.
  42. Yu X, Yue S, Wang M, Cao C, Liao Z, Ding Y, et al. Risk factors related to peripherally inserted central venous catheter nonselective removal in neonates. Biomed Res Int. 2018;2018:3769376.
  43. Hosseini MB, Jodeiri B, Mahallei M, Abdoli-Oskooi S, Safari A, Salimi Z. Early outcome of peripherally inserted central catheter versus peripheral IV line in very low birth weight neonates. Feyz Med Sci J. 2014;17(6):561-567.
  44. Tomar RS, Gupta AK, Khan ID. Incidence of catheter related bloodstream infections after removal of peripherally inserted central catheters in preterm neonates. Int J Contemp Pediatr. 2020;7(2):282-286.
  45. da Costa Prado NC, da Costa Santos RS, Almino RH, de Lima DM, de Oliveira SS, da Silva RA. Variables associated with adverse events in neonates with peripherally inserted central catheters. Enferm Glob. 2020;19(3):58-67.
  46. Fu M, Yuan Q, Yang Q, Yu Y, Song W, Qin X, et al. Risk factors and incidence of central venous access device-related thrombosis in hospitalized children: a systematic review and meta-analysis. Pediatr Res. 2024;96(7):1568-1593.
  47. Shah S, Zemichael O, Meng HD. Factors associated with mortality and length of stay in hospitalized neonates in Eritrea, Africa: A cross-sectional study. BMJ Open. 2012;2(5):792-801.
  48. Pizzolorusso G, Turi P, Barlafante G, Cerritelli F, Renzetti C, Cozzolino V, et al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory Chiropr Man Ther. 2011;19(1):15.
  49. Lake ET, Hallowell SG, Kutney-Lee A, Hatfield LA, Del Guidice M, Boxer BA, et al. Higher quality of care and patient safety associated with better NICU work environments. J Nurs Care Qual. 2016;31(1):24-32.
  50. Lathrope P, Van Leeuwen M, Campbell D, Seiler K, Dvorak H, Schmelzel M, et al. Can improving continuity of care decrease length of stay in the NICU? Arusha, Tanzania: Evidence-Based Approach to Decreasing Length of Stay in the NICU; 2008.
  51. Thungjaroenkul P, Cummings G, Embleton A. The impact of nurse staffing on hospital costs and patient length of stay: A systematic review. Nurs 2007;25(5):255-265.
  52. PurKayaStha J, SuPraJa M, Lewis LE, Bhat R. A study on peripherally inserted central venous catheter in infants in tertiary care centre. Indian J Neonatal Med Res. 2017;5(2):PO21-PO26.
  53. Sengupta A, Lehmann C, Diener-West M, Perl TM, Milstone AM. Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics. 2010; 125(4):648-653.
  54. Greenberg RG, Cochran KM, Smith PB, Edson BS, Schulman J, Lee HC, et al. Effect of catheter dwell time on risk of central line-associated bloodstream infection in infants. Pediatrics 2015;136(6):1080–1086.
  55. Zingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol. 2011;32(1):42–49
  56. Carneiro TA, Nobre KS, Fontenele FC, Façanha AP, Ferreira RP. Peripherally inserted central catheter in newborns: association of number of punctures, vein, and tip positioning. Rev Esc Enferm USP. 2021;55:e20210043.
  57. Uygun I. Peripherally inserted central catheter in neonates: A safe and easy insertion technique. J Pediatr Surg. 2016;51(1):188-191.
  58. Njere I, Islam S, Parish D, Kuna J, Keshtgar AS. Outcome of peripherally inserted central venous catheters in surgical and medical neonates. J Pediatr Surg. 2011;46(5):946-950.
  59. Li X, Guo X, Wan X, Hu Y. Influencing factors of neonatal peripherally inserted central venous catheter (PICC)-related phlebitis: a systematic review, meta-analysis and network meta-analysis. Signa Vitae. 2023;19(2).
  60. Igarashi A, Okuno T, Shimizu T, Ohta G, Ohshima Y. Mechanical stimulation is a risk factor for phlebitis associated with peripherally inserted central venous catheter in neonates. Pediatr Int. 2021;63(5):561–564.
  61. Silva RMM, Lui AM, Ferreira H, Franca AFO, Lala ERP, Viera CS. Analysing the use of peripherally inserted central cateter in neonatology. Rev enferm UFPE on line. 2016;10(2):796-804.
  62. Varghese NV, Sa’ada OA, Afzal U, Khan N. PICC line in neonates: Indications and complications. A single Level 3 NICU experience in the UAE and review of literature. Golb J of Ped and Neonatal Car. 2021;3(2):1-5.

 

 

 

 

Iranian Journal of Neonatology
Volume 17, Issue 1
Winter 2026
Pages 8-19