Comparison of complications associated with upper- versus lower-limb PICC placement in infants

Background and objective. There is still controversy regarding whether placement of peripherally inserted central catheters (PICCs) in the upper or lower limb is associated with a lower risk of catheter-related complications. This study was conducted to compare complications associated with upper- and lower-limb PICC placement in infants admitted to the NICU. Methods. Present prospective cohort study included 200 infants (100 with upper-limb PICCs and 100 with lower-limb PICCs) hospitalized in the NICU of Shahid Akbarabadi Hospital in 2022 who received their first PICC during hospitalization. Data on demographic characteristics, insertion site, PICC duration, and complications, including leakage, sepsis, thrombosis, edema, phlebitis, pleural effusion, cardiac complications, and catheter displacement, were recorded. PICC insertion was performed by trained neonatal nurses under supervision, and tip position was confirmed by radiography and echocardiography. All infants were followed until discharge, and complications were analyzed using SPSS version 24 with chi-square tests. Results. Overall, 27.5% of the infants had complications, and no significant difference was observed between the two groups in the total complication rate. Sepsis (positive blood culture or PICC tip culture; upper limb = 10%, lower limb = 0%), edema (upper limb = 8%, lower limb = 0%), and tachycardia (upper limb = 0%, lower limb = 9%) showed significant differences, whereas phlebitis (upper limb = 5%, lower limb = 1%) did not show a statistically significant difference. Conclusion. Although there was no significant difference in the overall incidence of complications between premature infants with upper- and lower-limb PICCs, sepsis and edema were more frequent in the upper-limb group, whereas tachycardia was more frequent in the lower-limb group. Phlebitis was also more common in the upper-limb group, but the difference was not statistically significant.