Maintenance of peripherally inserted central catheters in general pediatric wards

Background: The peripherally inserted central catheter (PICC) has emerged as a useful option for long-term intravenous access in children, which has been increasingly required with the advancements in pediatric care. Long-term maintenance of PICCs is important for their functions, but little is known about this. We aimed to describe the PICC dwelling time in general pediatric wards, taking both complications and intentional routine removal into consideration, and explore the factors for long-term maintenance.Methods: We retrospectively examined the records of procedures performed by the pediatric PICC team between April 2020 and September 2023 at a children's hospital in Japan. We conducted a survival time analysis to depict PICC dwelling time and regression analyses to explore factors associated with successful PICC insertion and long-term maintenance of catheters.Results: The PICC team conducted 78 procedures during the study period, 66 (85%) achieved central venous access, and 57 (78%) of 73 inserted PICCs could be used until treatment completion. The most common indication was administration of antibiotics. Radioscopy was utilized in 18% of procedures. The median PICC survival time was 170 days, and the 75% PICC survival time was 52 days. Failure of PICC insertion was associated with the 4.5 Fr double catheter (odds ratio (OR), 0.16) and lower extremity puncture (OR, 0.24). Longer catheter survival was associated with the catheter tip in the superior vena cava (SVC; hazard ratio (HR), 0.15), which was confirmed by additional multivariate analysis (HR, 0.14).Conclusions: PICCs could be used for several months in children until complications required removal. Single-lumen catheter insertion into the SVC might be associated with longer catheter survival. Developing appropriate methods to reach the SVC remains our task.