Abstract:
Background: Peripherally inserted central catheter (PICC) is an important intravascular access for critically ill neonates and is widely used in neonatal intensive care unit (NICU). Phlebitis is one of the most common PICC-associated complications, with a negative impact on the PICC functionality. However, there remains insufficient research on the incidence and risk factors of PICC-associated phlebitis, particularly in preterm infants.
Objectives: To identify the incidence and explore the risk factors of PICC-associated phlebitis among preterm infants.
Methods: This is a single-center retrospective cohort study. Clinical data from all preterm infants who underwent PICC placement were collected in NICU of Nanjing Women and Children’s Healthcare Hospital in eastern China from January 01, 2019 to December 31, 2023. PICCs were divided into two groups as phlebitis group and non-phlebitis group. Based on random forest algorithm and LASSO regression, the risk factors of PICC-associated phlebitis were explored.
Results: A total of 536 PICCs inserted were included of which 161 PICCs were assigned to phlebitis group and 375 PICCs were assigned to non-phlebitis group. The incidence of PICC-associated phlebitis was 30.0% (161/536). The random forest algorithm showed that the model exhibited the least variation when the lambda (λ) value was 0.0318, the ranking according to the most contribution of PICC-associated phlebitis risk was non-central PICCs, number of attempts for successful insertions, lower limb venous catheterization, postmenstrual age at catheterization, weight at catheterization, gender, left limb venous catheterization, BPD. Multivariate Logistic regression analysis showed that non-central PICCs (OR 2.546; 95% CI 1.639-3.953), number of attempts for successful insertions ≥ 5 times (OR 2.579; 95% CI 1.012-6.571), and lower limb venous catheterization (OR 13.917; 95% CI 4.068-47.615) were risk factors for PICC-associated phlebitis among preterm infants.
Conclusions: The incidence of PICC-associated phlebitis was high among preterm infants with PICCs in NICU. Non-central PICCs, number of attempts for successful insertions ≥ 5 times, and lower limb venous catheterization served as risk factors of PICC-associated phlebitis among preterm infants.
Reference:Sun X, Xu W, Wang Q, Gu R, Ding P, Li J, Zhang A, Liu B. Risk factors for PICC-associated phlebitis in preterm infants using random forest algorithm. Eur J Med Res. 2026 Jan 28. doi: 10.1186/s40001-026-03911-1. Epub ahead of print. PMID: 41606679.