• Ketan Jumani, Sonali Advani, Nicholas G Reich, Leslie Gosey, and Aaron M Milstone.
• Division of Pediatric Infectious Diseases, Departments of Pediatrics, Johns Hopkins University, Baltimore, MD 21287, USA.
• JAMA Pediatr. 2013 May 1; 167 (5): 429-35.

ImportancePeripherally inserted central venous catheters (PICCs) are prone to infectious, thrombotic, and mechanical complications. These complications are associated with morbidity, so data are needed to inform quality improvement efforts.ObjectivesTo characterize the epidemiology of and to identify risk factors for complications necessitating removal of PICCs in children.DesignCohort study.SettingJohns Hopkins Children's Center, Baltimore, Maryland.ParticipantsHospitalized children who had a PICC inserted outside of the neonatal intensive care unit (ICU) from January 1, 2003, through December 31, 2009.Main Outcome MeasuresComplications necessitating PICC removal as recorded by the PICC Team.ResultsDuring the study period, 2574 PICCs were placed in 1807 children. Complications necessitating catheter removal occurred in 534 PICCs (20.8%) during 46 021 catheter-days (11.6 complications per 1000 catheter-days). These included accidental dislodgement (4.6%), infection (4.3%), occlusion (3.7%), local infiltration (3.0%), leakage (1.5%), breakage (1.4%), phlebitis (1.2%), and thrombosis (0.5%). From 2003 to 2009, complications decreased by 15% per year (incidence rate ratio [IRR], 0.85; 95% CI, 0.81-0.89). In adjusted analysis, all noncentral PICC tip locations-midline (IRR 4.59, 95% CI, 3.69-5.69), midclavicular (2.15; 1.54-2.98), and other (3.26; 1.72-6.15)-compared with central tip location were associated with an increased risk of complications. Pediatric ICU exposure and age younger than 1 year were independently associated with complications necessitating PICC removal.Conclusions And RelevanceNoncentral PICC tip locations, younger age, and pediatric ICU exposure were independent risk factors for complications necessitating PICC removal. Despite reductions in PICC complications, further efforts are needed to prevent PICC-associated complications in children.

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