Analysis of risk factors for primary non-central malposition of peripherally inserted central catheter tip in neonates with different diseases admitted to neonatal surgical department: a case-control study

Objectives To investigate the risk factors for primary non-central malposition of peripherally inserted central catheter (PICC) tip in neonates admitted to the neonatal surgical department, compare the malposition rates across different insertion sites in disease types, and explore whether different diseases affect PICC tip malposition. Design A retrospective case - control study conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

Setting A 3A women's and children's hospital in South China (Guangdong Province). Participants A total of 558 neonates aged ≤28 days who underwent PICC insertion between January 2019 and November 2024 were enrolled.

Neonates with congenital circulatory system malformations, incomplete clinical data and death or treatment withdrawal before tip positioning were excluded. Outcome measures The primary outcome was the incidence of primary non-central PICC tip malposition confirmed by X-ray or ultrasound within 24 h after insertion.

Secondary outcomes included comparison of primary non-central PICC tip malposition rates across different insertion sites and comparison of primary PICC tip malposition rates by insertion sites across different disease groups. Results 558 neonates were included in this study, including 460 cases with PICC tip in place and 98 with PICC tip malposition.

In binary logistic regression analysis, the PICC insertion site was considered an independent risk factor (OR 2.908, 95% CI 1.748, 4.840, p Conclusion Medical staff can choose appropriate upper or lower limb veins for PICC insertion without worrying about the impact of abdominal diseases or thoracic diseases on non-central PICC tip malposition. PICC insertion via the head and neck veins should be performed with caution in neonates, as these sites carry a high risk of primary non-central tip malposition compared with other insertion sites.