Risk Factors for Peripherally Inserted Central Catheter Malposition in Preterm Infants: A Multicenter Retrospective Study

Chunyan Liang ¹ Jinming Liu ¹ Yingzi Tang ¹ Wenpiao Zhao ¹ Ruining Xin ¹ Xiaoqun Gu ¹ Fang Huang ^1* Yu'e Lai ^1* Wangjin Huang ² Yanhong Liu ³ Mei Lin ⁴ Lili Pan ⁵ Guirong Cao ⁶ Sudan Tan ⁷ Chunliu Wei ⁸ Fangyuan Lin ⁹

• ¹ Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
• ² Guilin maternal and Child Health Hospital, Guilin, China
• ³ Yulin Maternal and Child Health Hospital, Yulin, China
• ⁴ Qinzhou Maternity and Child Health Care Hospital, Guangxi, China
• ⁵ Naning Maternity And Child Health Hospital, nanning, China
• ⁶ Minzu Hospital of Guangxi Zhuang Autonomous Region, nanning, China
• ⁷ The People's Hospital of HeChi, Hechi, China
• ⁸ The First People's Hospital of Hechi, Hechi, China
• ⁹ Bobai County People's Hospital, Bobai, Bobai, China

Objective: To explore the risk factors affecting peripherally inserted central catheter (PICC) tip malposition in preterm infants. Methods: A retrospective collection of clinical data from preterm infants who underwent PICC placement in the neonatal departments of Guangxi Maternal and Child Health Hospital and eight other hospitals from January 2021 to April 2024 was conducted. The incidence of catheter tip malposition was analyzed. The infants were divided into two groups based on the occurrence of catheter tip malposition: the malposition group and the non-malposition group. Multifactorial logistic regression and multimodel logistic regression analyses were employed to explore the influencing factors of PICC tip malposition in preterm infants. Results: A total of 1449 infants were ultimately included in the study, with an incidence of catheter tip displacement of 12.56% (182 out of 1449). Adjusted results from multimodel regression analysis of covariates indicated that Sample selection location in Guilin (OR=2.30, 95%CI:1.24~4.25),Yulin (OR=4.35,95%CI: 2.27 ~8.34) and Qinzhou (OR=2.63 , 95%CI:1.37 ~5.08), duration of catheter insertion procedure (OR=1.01, 95%CI: 1.01~1.02), duration of catheter dwell (OR=1.04, 95%CI: 1.02 ~1.07), weight percentile at the time of catheter malpositioning(OR=11.39, 95%CI:4.81 26.95), extremely preterm group(<28 weeks gestation) (OR=4.42, 95%CI: 1.29 ~15.16) were risk factors for catheter tip displacement. Additionally, site of PICC catheterization in neck as a risk factor (OR=3.48 , 95%CI: 1.89 ~6.40).Conclusion: Sample selection location in Guilin, Yulin and Qinzhou, duration of catheter insertion procedure, duration of catheter dwell,weight percentile at catheter removal, extremely preterm group (<28 weeks gestation) and site of PICC catheterization in neck may increase the risk of PICC catheter tip malposition.