Complications in the use of neonatal peripherally inserted central catheters: contributions to the clinical practice

Felipe Lopes Gomes¹, Angelina Maria Aparecida Alves², Adriana Texeira Reis¹, Rachel Leite Soares de Vasconcelos¹

¹Universidade do Estado do Rio de Janeiro. Rio de Janeiro (RJ) Brazil. ²Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro (RJ) Brazil.

Introduction

Peripherally inserted central catheters (PICCs) are essential devices that support treatment in intensive care patients, including those in the Neonatal Intensive Care Unit (NICU). Newborns (NBs) frequently admitted require intravenous support, since their physiological capacities are immature and they demand specific treatments such as prolonged intravenous antibiotic infusions, parenteral nutrition, and other vasoactive therapies, therefore they require central venous access to ensure lower risk of extravasation and phlebitis, especially in NBs in whom peripheral venous access is difficult to maintain¹.

In addition to term NBs, that is, those born at 37 gestational weeks or later, there are premature NBs (preterm NBs). Premature status applies to every NB born before completing 37 weeks of gestation. According to gestational age, this condition may be divided into three categories: extreme prematurity (less than 28 weeks), moderate prematurity (between 29 and less than 33 weeks), and borderline prematurity (between 34 and 36 weeks). The occurrence of preterm births is strongly associated with increased infant morbidity and mortality rates, representing one of the leading causes of deaths in the neonatal period. Beyond the clinical impact, care for these newborns represents a major economic challenge for health services. In this context, assessment of health system efficiency through continuous monitoring of trends and indicator variations, especially those related to prematurity, becomes indispensable¹⁴.

For treatment of these NBs, PICC stands out as a central catheter inserted into a peripheral vein that advances to a large-caliber central vein, such as the superior vena cava, with the tip fixed at the cavoatrial junction when inserted in upper limbs. Due to this characteristic, it presents low complication rates and ensures effective management of therapy similar to any other central venous catheter².

Among benefits associated with PICC use, this device meets specific therapeutic needs, such as continuous and safe administration of medications, parenteral nutrition, and chemotherapeutic agents for prolonged periods. This access helps reduce the number of peripheral venipunctures and avoids surgical interventions, which makes intravenous therapy more efficient and uninterrupted. In addition to representing an economically advantageous alternative compared with surgically implanted devices, it enables long-term infusions with low infiltration risk, which reduces neonatal discomfort and lessens the burden on the care team due to repeated punctures¹⁵.

The National Patient Safety Policy adopts as primary definitions reduction in risk of unnecessary harm in healthcare delivery to a minimum acceptable level, including harms such as injuries, suffering, death, disability, or dysfunction, among others. It also promotes a culture in which professionals involved in care and managers must assume responsibility for their own safety and safety of their colleagues, as well as safety of patients and relatives³.

Given this context, early identification of complications by nurses is extremely relevant technically and ethically. These professionals must periodically assess the catheter insertion site to detect hyperemia, secretion, and signs of catheter rupture. PICCs are associated with a wide range of potential complications, some of which may pose immediate life-threatening risk⁴.

Among complications, noteworthy events include catheter migration or displacement, with possible loss of function or perforation of adjacent structures; gas embolism, frequently related to accidental disconnections; local or systemic bleeding; solution extravasation, particularly concerning when hyperosmolar solutions are involved; cardiac arrhythmias due to myocardial stimulation; cardiac tamponade and right atrial perforation, especially in cases of inadvertent deep insertion; and pleural or pericardial effusion, resulting from vascular injuries⁴.

Another worrisome event involves healthcare-associated infections (HAIs). These infections represent one of the greatest challenges to patient safety and one of the main adverse events that affect users of health services worldwide. The risk of HAI acquisition is significantly higher in Intensive Care Units (ICUs). Such complications have direct impact on care quality, may compromise the patient clinical course, and are significantly associated with increased mortality, particularly in vulnerable populations such as NBs admitted to NICUs⁵.

These infections rank among the most significant, serious, and concerning complications associated with central venous catheter (CVC) use. Bacteria and other microorganisms may invade tissues through the catheter and cause bloodstream infections or infections in vital organs and systems. Bloodstream infections may progress to sepsis, a potentially fatal condition. Occurrence of infectious complications may be directly related to catheter handling, which must comply with specific infection prevention guidelines, such as use of sterile gloves, antiseptics, and hand hygiene. The technique known as “scrub the hub” is also essential to prevent CVC-related infections^2,6.

Resolution 258/2001 issued by the Federal Nursing Council authorizes nurses to insert and handle PICCs, provided they undergo appropriate professional qualification and training for this activity⁷.

In neonatology, PICC use has become increasingly common, which requires nurses to develop specific training and knowledge for monitoring, handling, and application of appropriate techniques for catheter maintenance and care throughout its dwell time, a scenario that demands studies on this topic.

The importance of deepening knowledge on PICC use in NBs arises from practical observation that even in units where nursing teams have adequate technical training for insertion and management of this device, catheter dwell time does not always extend until completion of proposed therapy. This reality points to multiple clinical, technical, and care-related factors that may interfere with device maintenance and favor complication onset. Therefore, systematic investigation of these factors becomes essential to support evidence-based strategies that promote patient safety, care quality, and effectiveness of intravenous treatment in neonates. In addition, understanding circumstances associated with PICC-related events contributes to improvement of institutional protocols and strengthens the role of nurses in clinical decision-making in neonatal intensive care.

Based on these considerations, the objective is to analyze PICC use and complications in NBs admitted to a public NICU, characterizing the clinical and epidemiological profile of this population and identifying factors associated with device-related complications that culminate in catheter removal.

Method

This descriptive, documentary study was conducted in a neonatal unit of a large public university hospital that provides care to high-complexity patients in Rio de Janeiro, RJ.

Documentary research has characteristics similar to those of bibliographic research, differing from it regarding data sources⁸.

The unit has 15 NICU beds and 6 conventional intermediate care beds (UCINCo), although during the study period only 3 UCINCo beds were active. The service includes a multiprofessional team and residents in different areas. The nursing team comprises 38 nurses and 10 nursing residents.

It provides care to NBs whose mothers received prenatal care at the institution due to high-risk pregnancy, as well as NBs transferred from other health units with clinical and surgical problems. In addition, it is a referral center for therapeutic hypothermia in the State of Rio de Janeiro, with 2 beds available for this purpose, and it receives NBs with congenital heart disease. There is a wide range of cases, since the unit is part of a general hospital that performs different surgical procedures in this population and offers resources to care for high-complexity pregnant women.

Each year, the unit offers a training course on PICC placement and maintenance aimed at capacitating residents and nurses in the unit and providing updates to professionals already trained for this procedure. This course is offered not only to professionals in the neonatal unit, but also to professionals and residents in pediatric care. Standard operating procedures for catheter insertion, maintenance, dressing, and removal are available in the unit and updated annually.

Data collection was carried out in medical records of neonates and infants who used PICC between 2020 and 2024. Inclusion criteria were: NBs of any gestational age who underwent PICC insertion in the NICU between January 2020 and July 2024, including those who died. Infants whose records did not provide sufficiently accurate information or lacked data related to PICC use were excluded (23 records in total). Infants were included because, due to the complexity of their conditions at admission, they remained in the unit beyond 28 days, which, according to the Ministry of Health, no longer classifies this population as NBs.

Data were obtained through the PICC monitoring and evaluation instrument used in the unit, which is completed by the nurse who performs the procedure and remains in the unit until device removal. After removal, this form is stored in a folder kept in the unit head’s office. Electronic medical records were also consulted in cases of missing or inconsistent information relevant to the study in the printed form.

The instrument contains data that characterize patients who underwent PICC insertion, such as gestational age, admission date, corrected gestational age, birth weight, current weight, classification (AGA / SGA / LGA), diagnosis, and days of life, which are included in item I of the form. Catheter insertion data are recorded in item II of the instrument and include, for example, catheter type, number of lumens, length, PICC positioning, catheter-related events, dressing change control, and catheter removal, among others.

In compliance with Resolution 466/2012 of the National Health Council (CNS), which regulates research involving human beings, this study was approved by the Research Ethics Committee under number 6.954.751.

Waiver of the Free and Informed Consent Form was requested, since there was no direct contact with research participants or their guardians, as only documents completed by unit nurses were used.

Data collection took place between July and August 2024. Careful processing of missing data was performed, with exclusion of incomplete records and consistency analysis of the variables included.

Collected data were digitized and entered into a spreadsheet created in Google Sheets®, used as a tool for organizing and initially processing information. Variables from the data collection instrument were arranged in specific columns corresponding to gestational age, birth weight, clinical diagnoses, indication for therapy, puncture site, catheter tip positioning, dwell time, and reason for removal. Each row of the spreadsheet represented one medical record, ensuring direct correspondence between cases and study variables.

Structuring data in the digital environment enabled assessment of information completeness, standardization of records, and identification of inconsistencies. For numerical variables — gestational age, birth weight, and catheter dwell time — mean and median were calculated as measures of central tendency directly in the spreadsheet, using integrated statistical functions in Google Sheets®. This step allowed an initial descriptive analysis of data, supported understanding of the sample profile, and informed the discussion of results.

Results
A total of 263 medical records of NBs who used peripherally inserted central catheters between January 2020 and July 2024 were analyzed. A total of 23 records were excluded from the results because they contained incomplete information related to the catheter. After exclusion, 240 records remained for data analysis. Only the number of insertions was considered, even when referring to the same NB, without distinguishing sociodemographic characteristics, but only clinical and epidemiological aspects. To assess clinical variables, gestational age and weight at the moment of insertion were analyzed.
Analysis of clinical and epidemiological data showed mean gestational age at birth of 33.2 weeks (SD ± 0.5), with median of 32.5 weeks and range between 25.4 and 41.4 weeks. Regarding birth weight, mean of 2,045 grams (SD ± 141 g) was observed, median of 1,620 g, with values ranging between 468 g and 6,500 g.
These findings emphasize heterogeneity in the neonatal profile cared for in the service, including both premature and term NBs, and indicate complexity and diversity in care provided.
The Parkin variable estimates a gestational age score based on physical characteristics in NBs. As shown by the findings, gestational age and weight at insertion were considered parameters for NB classification. The minimum weight was classified as extremely low weight (468 grams) and gestational age as extreme prematurity (25.4 weeks). Mean gestational age and weight at insertion are consistent with prematurity, the main diagnosis in the population studied (Table 1).

Table 1 - Distribution of the diagnoses corresponding to the NBs that used PICCs during the 2020-2024 period (N=240). Rio de Janeiro (RJ), Brazil, 2025.

Diagnoses	N	%
Prematurity	112	46.6%
Congenital cardiopathy	33	13.7%
Respiratory distress	31	12.9%
Perinatal asphyxia	18	7.5%
Others	16	7.0%
Congenital malformation	8	3.3%
Intestinal obstruction	4	1.6%
Postoperative	4	1.6%
IUGR	3	1.2%
Sepsis	3	1.2%
Syndromes	2	0.8%
Hypoglycemia	2	0.8%
COVID-19	2	0.8%
Congenital Syphilis	2	0.8%
Total	240	100.0%

The “others” category includes diagnoses with only one occurrence: Bronchopulmonary dysplasia, Pneumonia, Encephalopathy, Chronic Kidney Disease, Colon Perforation, Bilateral Hydronephrosis, ABO Incompatibility, Apnea, Diabetes, Abdominal Distension, Pulmonary Hypertension, Pulmonary Hemorrhage, Choroid Plexus Tumor, Pneumoperitoneum, Dehydration, and Congenital Neurosyphilis.

Only one indication prevailed for catheter insertion in most data. Less frequent indications corresponded to those with more than one indication. In most cases, more than one criterion supported PICC insertion, as shown in Table 2.

Table 2 - Indications for PICC catheter use in the NBs during the 2020-2024 period (N=240). Rio de Janeiro (RJ), Brazil, 2025.

Category	Composition / Description	N	%
1. Isolated therapies
Total Parenteral Nutrition (TPN)	NPT alone	66	27.5%
Antibiotic therapy	Exclusive	44	18.3%
Drug therapy	Exclusive (use of vasoactive drugs, sedatives, anti-convulsing agents, etc.)	37	15.4%
Venous Hydration (VH)**	Exclusive	16	6.6%
Subtotal – Isolated		163	67.8%
2. Combined therapies (two associations)
TPN + Antibiotic therapy		29	12.1%
TPN + Drug therapy		17	7.1%
TPN + VH		13	5.4%
VH + Antibiotic therapy		12	5.0%
VH + Drug therapy		3	1.2%
Drug therapy + Antibiotic therapy		1	0.4%
Subtotal – Two associations		75	31.2%
3. Multiple therapies (three or more associations)
TPN + VH + Drug therapy		1	0.4%
TPN + VH + Antibiotic therapy		1	0.4%
Subtotal – Multiple associations		2	0.8%
Overall total		240	100.0%

Regarding catheter dwell time, considering all eligible insertions (240), mean duration was 10 days (SD ± 0.7), with median of 7 days. Minimum time was less than 24 hours, whereas maximum dwell time reached 45 days.

Regarding catheter insertion site, across the four years of analysis it was possible to identify the vein most frequently selected during the procedure, without specifying the limb used. During data analysis, nonspecific terms appeared due to limitations in the catheter insertion data instrument, which lacked precision and underwent significant modifications during the collection period. As shown in Table 3, right upper limb, left upper limb, and left lower limb were recorded.

Table 3 - Preferred veins to insert PICC catheters in the NBs during the 2020-2024 period (N=240). Rio de Janeiro (RJ), Brazil, 2025.

Variables	N	%
Cephalic vein	53	22.1%
Basilic vein	42	17.5%
Jugular vein	24	10.0%
Saphenous vein	23	9.6%
URL	22	9.1%
Median cubital vein	16	6.6%
Temporal vein	15	6.2%
ULL	15	6.2%
Axillary vein	10	4.1%
Metacarpal veins	9	3.7%
Popliteal vein	4	1.6%
Retroauricular vein	2	0.8%
Brachial veins	2	0.8%
Radial veins	1	0.4%
Femoral veins	1	0.4%
LLL	1	0.4%
Total	240	100.0%

Regarding the final positioning of the catheter tip, four categories were listed to facilitate comprehension of the results, namely: Central, for catheters that, on radiographic visualization, were located between the 1st and 4th intercostal spaces for catheters inserted in upper limbs, or between T8 and T10 for catheters inserted in lower limbs, and/or those clearly visualized at the cavoatrial junction.

The second category was Midline, referring to catheters whose tip did not extend beyond the subclavicular vein when inserted in upper limbs, and/or did not reach the T10 level for catheters inserted in lower limbs.

The third category included the peripheral ones, meaning catheters that did not progress beyond the subclavicular vein in upper limbs, and/or those whose tip remained in the jugular vein when inserted in the cephalic region. The last category encompassed the intracardiac catheters, positioned beyond the 4th and 5th intercostal spaces, above, or clearly visualized within cardiac chambers.

There was predominance throughout all years in the most adequate position, which is the central one. The second category comprised the Midline catheters. The third category included the peripheral catheters. The last category, the intracardiac catheters, remained in use due to therapy feasibility.

It is important to highlight that, regarding the catheter tip, all were considered after assessing the need for traction or not. All of them had their locations confirmed through radiographic examination.

Table 4 - X-ray verification of PICC catheter tip position in the NBs during the 2020-2024 period (N=240). Rio de Janeiro (RJ), Brazil, 2025.

Variables	N	%
Central	156	65.0%
Midline	22	9.1%
Peripheral	13	5.4%
Intra-cardiac	49	20.4%
Total	240	100%

Among the reasons for PICC removal, all factors listed in the data collection instrument for catheter insertion were considered and categorized. Among them, treatment completion stands out as the main reason for removal in all years, followed by external rupture, which gained greater relevance between 2021 and 2023, and by phlebitis, infiltration, and edema as the main reasons for catheter removal. Signs of infection or infection itself represented the fourth most frequent finding during the analysis.

Other frequent reasons included peripheral positioning, death, obstruction, hyperemia, unit transfer, catheter replacement, and exteriorization. Hypoperfusion of limbs, displacement, and hospital discharge presented very low incidence as reasons for removal; therefore, they were not included in the results. It is worth noting that death, although included as a cause of removal, was not directly related to the catheter but to other factors associated with the patient’s clinical condition.

Table 5 – Reasons for removing PICCs in the NBs during the 2020-2024 period (N=240). Rio de Janeiro (RJ), Brasil, 2025.

Variables	N	%
Treatment conclusion	105	43.7%
External rupture	29	12.1%
Edema / Infiltration / Phlebitis	29	12.1%
Infection signs or actual infection	16	6.6%
Peripheral	15	6.2%
Deaths	11	4.6%
Obstruction	11	4.6%
Hyperemia	6	2.5%
Unit transfer	6	2.5%
Catheter exchange	5	2.1%
Externalization	4	1.6%
Poor perfusion in the limbs	1	0.4%
Displacement	1	0.4%
Hospital discharge	1	0.4%
Total	240	100%

Discussion

The distribution of clinical diagnoses among newborns who used PICC aligns with findings from another study⁹ where most insertions occurred in newborns below 1,500 grams, emphasizing extreme low birth weight as a factor associated with prematurity, a predominant complication in Neonatal Intensive Care Units^4,9-10,15.

It is relevant to mention that low birth weight and extreme prematurity remain among the main risk factors for catheter complications. The results corroborate recent literature, with studies highlighting the vulnerability of premature newborns and the role of PICC in reducing venous punctures and adverse events^2,9,11.

The insertion of PICC in extreme premature newborns constitutes a fundamental practice to optimize care and contributes significantly to care quality. By reducing exposure to painful procedures and skin barrier breaches, PICC promotes more humanized and safe care, while facilitating effective treatment completion. By providing stable and secure device access, the catheter enables continuous administration of medications and nutrients, thereby reducing pain and stress, and supporting newborn development and well-being¹⁰.

Regarding indications, the results also align with the literature, confirming that the need for prolonged intravenous therapy, whether for antibiotic administration, parenteral nutrition, or other medications, represents the primary reason for PICC insertion, particularly in premature newborns with low weight, 1500 g or less^9-10,15.

Concerning catheter dwell time variation in days, particularly the mean and median reported in this study data collection, it demonstrates the need for prolonged intravenous therapies. As shown in a retrospective study¹⁵ reporting a mean of 5.8 days of catheter use, close to the mean found here and emphasizing PICC utilization in prolonged therapies¹⁵.

Studies indicate that prematurity ranks among the main triggers of transient metabolic and hydroelectrolytic disorders. This condition, resulting from immaturity of various systems and organs, requires administration of large volumes of intravenous solutions, thereby prolonging device dwell time such as PICC and consequently increasing the risk of bloodstream infection^10-11,14.

It was possible to identify that less specific nomenclatures were frequent during 2020 and 2021. Starting in 2022, a new instrument for procedure information collection was implemented, which made record-keeping in patient charts regarding PICC more objective and precise.

Standardization of forms and nomenclatures in health procedure records emerges as an essential strategy to promote care quality and patient safety. Adoption of standardized instruments, as observed from 2022 onward, enabled greater precision in clinical information collection and recording, significantly reducing the use of unspecific terminology^18-19.

Such standardization facilitates communication among health professionals, minimizes interpretive ambiguities, and contributes to care traceability. Furthermore, standardization supports integration among information systems, enhances operational process efficiency, and ensures compliance with regulatory agency standards. In this context, standardized practices not only enhance care quality but also constitute a fundamental basis for safe and effective health service management^18-19.

Upper limbs represented the primary choice for puncture, with predominance of right and left cephalic veins and slight increase in lower limb punctures, with the saphenous vein as the main choice. The basilic vein appeared less frequently as a choice but still prevailed over other puncture sites, such as jugular, saphenous, and temporal veins, for example. This finding contradicts literature recommendations, where right upper limb veins, particularly the basilic vein, should prevail as the primary choice among others. However, PICC should be inserted in the largest possible caliber vein, always considering that the catheter diameter must not exceed one third of the vessel diameter^9-10.

This site receives preference due to the catheter path to its ideal position, passing through the axillary vein to the superior vena cava. It offers the shortest and easiest access route, with larger caliber blood vessels that are easily palpable, along with favorable anatomy, which facilitates access maintenance during dressing changes^9-10.

However, this insertion site data suffered from lack of precision in the analyzed records, even in electronic charts. Thus, the importance of continuing education in health services stands out, aimed at enhancing team skills, encouraging professional development, and implementing evidence-based care routines. The institution, together with teams responsible for continuing education, must promote frequent training and strategies, along with updates on insertion, maintenance, and main issues that may arise during treatment¹⁰.

PICC insertion site holds crucial importance for proper catheter progression, which minimizes puncture numbers, facilitates maintenance, and reduces incidence of complications that may lead to catheter loss, early removal, therapy interruption, or even patient complications such as bloodstream infection^9-10.

A retrospective cohort study¹⁶ with 76 adult patients identified that external jugular vein choice associated with PICC insertion difficulty and complications¹⁶.

The ideal catheter tip location lies in the lower third of the superior vena cava. On radiological view, for newborns, it corresponds to between the 3rd and 4th intercostal spaces for catheters inserted in upper limbs. For catheters inserted in lower limbs, the most adequate location is the inferior vena cava, which on radiological view should appear between T8 and T10 vertebrae, above the diaphragm, considering possible anatomical variations¹³.

This data proved highly variable during collection and lacked specificity due to the data instrument, mainly during 2020 to 2021, where the instrument did not use standardized nomenclatures, leaving information completion at the nurse’s discretion. Nevertheless, it was possible to observe that, in subsequent years after instrument change (2022 to 2024), the central position remained the main target on radiological observation, conferring lower complication risk¹⁰.

Regarding catheter tip location, between 2022 and 2024, a slight decrease occurred in Midline and peripheral catheters. Intracardiac positioning maintained constant presence throughout all years. During analysis, use of unspecific nomenclatures (“above the umbilical scar”, “above the diaphragm”, “at iliac crest height”) appeared mainly for catheters inserted in lower limbs; radiological view confirmed that these catheters remained peripheral by failing to reach the ideal final position.

Once again, the importance of training emerges here so nurses perform adequate procedure recording, aiming at unit nomenclature standardization in line with literature terminology, since record standardization holds extreme importance for ensuring communication and adequate care¹⁸.

A study¹¹ highlighted in its research the importance of proper PICC positioning. An example occurs when the catheter locates intracardiacally, often requiring traction, which elevates complication risk¹¹.

Among complications leading to PICC removal over the years, external rupture (N=29, 12.1%) proved most prevalent. Catheter rupture may associate with team handling, resulting from inadequate pressures during infusion therapy. To reduce rupture risk, testing catheter patency at each manipulation proves important, along with using appropriate gauge syringes, replacing cannulas, connectors, extensions, and sets if clots detected or at pre-established intervals, plus following recommended and safe protocols for catheter declotting⁴.

Infiltration, edema, and phlebitis represent other complications well present in data analysis. Overall, 29 of 240 catheters (12.1%) had one or more of these complications listed as removal reason. Regarding infiltration, this complication may associate with catheter traction, compromising rapid infusion dilution, which may erode internal vascular wall structures, leading to various complications such as medication leakage, pleural effusion, pericardial effusion, or even cardiac tamponade. Moreover, unplanned catheter removal commonly occurs due to this complication⁹.

Mechanical phlebitis may associate with venous wall irritation, which can result from using a catheter with excessive gauge relative to the vessel, insertion trauma, use of rigid material catheters, and minor traumas caused by catheter movement within the vessel^4,9,15.

To prevent phlebitis, prioritizing certain practices proves important: hand hygiene, minimizing catheter handling, appropriate gauge selection, preference for upper limb insertion, use of disposable tourniquets or disinfection after use, powder-free gloves, sterile, waterproof, and transparent dressings, and recording insertion site (including date, time, and responsible professional)^4,9,11,15.

Furthermore, adopting protocols to standardize nursing practices and records, along with implementing educational activities to raise nurse awareness about risk factors in these cases, remains essential. Adequate catheter fixation, daily monitoring, and regular radiographs for catheter location receive recommendation⁹.

Infection or signs of infection also emerged as a complication in data analysis. Overall, 16 of 240 catheters (6.6%) had infection or signs of infection as removal reasons. In contrast, a cohort study¹⁷ evaluated 610 PICCs in neonates and found 14.6% removal due to suspected infection¹⁷.

To prevent this occurrence, clinical care measures receive recommendation to reduce infection risk, such as: hand hygiene before and after handling with antiseptic solution; daily inspection of catheter integrity and function, especially in cases of adverse events or infusion problems; disinfection of cannulas and connectors with 70% alcohol; verification of catheter patency at each use; use of appropriate gauge syringes; proper dressing performance and maintenance; and replacement of cannulas, connectors, extensions, and sets if clots present or at established intervals^4,9.

Factors such as low birth weight, prematurity, catheter size, number of lumens, catheter material type, anatomical insertion site, aseptic insertion, and prolonged catheter dwell time may increase infection risk. Moreover, changing dressings at established periods or immediately if soiled proves fundamental²⁰.

These cares aim to ensure catheter integrity and minimize infectious complication risk. Use of transparent dressings facilitates insertion site visualization, allowing early detection of possible infection or complication signs, such as redness, edema, or exudate. Furthermore, rigorous asepsis maintenance during dressing changes and constant catheter monitoring remain essential to prevent infections, especially in more vulnerable patients such as newborns and prematures^13,20.

This study limitations include the high number of venous access control forms with incomplete or imprecise filling, which limited sociodemographic characterization of the sample. Additionally, the unit’s electronic chart had not yet been fully implemented at the analyzed period start, in 2020.

Conclusion

The PICC catheter constitutes essential technology in neonatal care, particularly for premature newborns. This study revealed that main complications associated with PICC use stem from technical and operational factors, such as rupture, infiltration, and infection, thereby reinforcing the need for continuous training and strict adherence to insertion and maintenance protocols.

Findings also indicate that strengthening continuing education and process auditing can reduce complications and enhance neonatal patient safety. This study contribution lies in supporting evidence-based practices for safe PICC management in neonatal units, thereby promoting care quality and safety.

Research focusing on maintenance and handling protocol efficacy is suggested, comparing approaches to prevent complications such as rupture and extravasation. Implementation of auditing systems, such as the proposed checklist, could also serve as a tool to reduce adverse events.

Authors' contributions

Conception of this study: Felipe Lopes Gomes; Data collection: Felipe Lopes Gomes. Data analysis and interpretation: Felipe Lopes Gomes and Angelina Alves. Writing of the manuscript: Felipe Lopes Gomes, Angelina Alves, Adriana Reis and Raquel Soares. Critical review of the manuscript: Felipe Lopes Gomes, Angelina Alves, Adriana Reis and Raquel Soares. Approval of the final version of the article: Felipe Lopes Gomes, Angelina Alves, Adriana Reis and Raquel Soares.

Conflict of interest

The authors declare that there is no conflict of interests.

Acknowledgments

To my advisors, my sincere thanks for constant encouragement toward publication of this study and for active participation in all stages of its development. Theoretical contributions, methodological guidance, and academic support proved fundamental to article enhancement and to my professional and scientific growth.

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Name: Felipe Lopes Gomes

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