Method for Determination of Peripherally Inserted Central Catheter (PICC) Insertion Length in Infants

A PICC (peripherally inserted central catheter) is a catheter in which the tip resides in a central vein via percutaneous insertion from a peripheral vein. A neonatal PICC can be inserted at the patient's bedside and it can remain in place for several weeks. The small diameter of its lumen is ideal for the extremely small neonate. However, the placement and maintenance of peripheral intravenous catheters in preterm infants is difficult and can become a challenge for clinicians. The complications of PICC placement have been previously reported as infection, thrombosis, phlebitis, bleeding and misplacement. The complication rate of PICCs is associated with the location of their tips. Centrally placed catheter tips are associated with fewer complications compared with non-centrally placed catheter tips (Jumani, Advani et al. 2013). Therefore, the tip location of PICC is an important factor in reducing the complication rate of PICC. The determination of PICC insertion length traditionally depends on the direct measurement of length between two anatomical landmarks on the infant's body. In 2019, Chen et. al. introduced a mathematical formula to determine the PICC insertion length using anthropometric measurement. This study aims to recruit 72 infants less with a birth weight of less than 1500g that will be randomised into either the mathematical formula or direct measurement method in the insertion length determination. The outcomes will include the proportion of infants with appropriate PICC tip placement and rate of complication within the first two weeks post insertion. We hypothesized that determination of the length of insertion of PICC in neonates using mathematical formula based on body measurement has higher successful rate with lower rate of complication compared to direct measurement.