Use and Outcomes of Peripherally Inserted Central Catheters in Hospitalized Infants

OBJECTIVE The optimal strategy to prevent catheter-related thrombosis (CRT) in children remains unclear. We aimed to characterize the appropriateness of peripherally inserted central catheters (PICCs) in hospitalized infants and to explore the feasibility of a randomized clinical trial (RCT) of antiplatelet therapy to prevent CRT in these infants. METHODS We conducted a multicenter retrospective cohort study of hospitalized infants younger than 1 year who had a PICC inserted between January 2017 and December 2020. We collected infant and PICC-related data from electronic medical records. Appropriateness of PICCs was assessed using the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics guidelines. Feasibility of the RCT was assessed based on frequency of CRT and availability of patients. RESULTS A total of 434 infants were studied. Median age was 17 days (IQR: 4, 96 days). Of these, 153 (35.3%) infants were at risk of bleeding with antiplatelet therapy, whereas 103 (23.7%) were nil per os, including medications. PICCs were considered appropriate in 257 (82.6%) infants. Proportions of appropriate PICCs were lower in PICCs with durations of 0 to 7 days (60.6%) and in infants older than 30 days (74.0%) or not admitted to the intensive care unit (75.6%). CRT occurred in 22 (5.1%) infants or 2.2 cases (95% CI: 1.2–4.1 cases) per 1000 PICC-days. CRT was associated with elevated mean platelet volume (risk ratio: 3.14, 95% CI: 1.68–5.84). CONCLUSION Opportunities exist to reduce the number of PICCs inserted in hospitalized infants. An RCT of antiplatelet therapy to prevent CRT may be challenging.