Does limb position influence PICC tip location
Extract:
“Clinical scenario: A 4-day-old baby, born at 28 weeks of gestation, was transferred from a District General Hospital to a tertiary neonatal unit following a respiratory deterioration. On admission, the X-ray showed a left basilic neonatal peripherally inserted central catheter (n-PICC) lying in a suboptimal place in the axillary vein. After stabilisation, a new n-PICC was inserted.
A repeat X-ray unexpectedly showed the original line at an optimal position in the lower superior vena cava. The only difference was the baby’s arm position, which changed from being perpendicular to side-lying, prompting concern about whether limb position affects line tip interpretation.
Structured clinical question: In neonates with an n-PICC, does limb position (upper or lower) affect the interpretation of catheter tip location on imaging? If so, what is the optimal limb position, based on literature, for X-ray imaging?
Search: A Medline and Embase search (1980–30 March 2023) using (newborn OR neonat* OR pediatric*) AND (PICC OR peripherally inserted central catheter) AND (arm position OR limb position OR extremity) identified 388 neonatal or mixed neonatal and paediatric studies, which investigated the influence of limb position on PICCs. After screening, seven observational studies met the inclusion criteria—six using X-ray for n-PICC tip confirmation and one using ultrasound. Five focused on neonates, while two included broader paediatric populations due to limited neonatal data. The sample size was variable, with four papers having ≥80 n-PICC insertions, while the smallest study included had 14 n-PICC insertions.”
Reference:
Pallickal AM, Pappa O. In neonates with a peripherally inserted central catheter (n-PICC), does limb position influence catheter tip location on X-ray? Arch Dis Child. 2025 Dec 31:archdischild-2025-329603. doi: 10.1136/archdischild-2025-329603. Epub ahead of print. PMID: 41475894.