Pediatric peripherally inserted central catheters: Complication rates related to catheter tip location

Objective. To compare complication rates between central venous catheter ti p location and noncentral tip location after peripherally inserted central catheter (PICC) placement in children. Methods. Between 1994 and 1998, data from all children who underwent PICC p lacement were analyzed. Patient demographics, catheter characteristics, cat heter duration, infusate composition, and catheter complications were enter ed prospectively into a computerized database. Catheter tip locations were determined by fluoroscopy and were defined as central if they resided in th e superior vena cava, right atrium, or high inferior vena cava at or above the level of the diaphragm, and as noncentral if located elsewhere. Differe nces in complication rates between the central and noncentral groups were a nalyzed. Results. Data from a total of 1266 PICCs were analyzed from 1053 patients w ith a mean age of 6.49 +/- .2 years (range: 0-45.0 years). Of the 1266 PICC s, 1096 (87%) were central in tip location, and 170 (13%) were noncentral i n tip location. The central group had 42 complications of 1096 catheters (3 .8%), while the noncentral group had 49 complications of 170 catheters (28. 8%). Controlling for patient age, catheter size, gender, and catheter durat ion with a logistic regression model, there remained a statistically signif icant increased likelihood of complication in the noncentral group versus t he central group (adjusted odds ratio: 8.28; 95% confidence interval: 5.11- 13.43). Conclusions. Centrally placed catheter tips are associated with fewer compl ications than are noncentrally placed catheter tips. Clinicians should ensu re that catheter tips reside centrally after PICC placement in infants and children.