Determining the position of peripherally inserted central catheter tips in neonates: A review of common methods over the last two decades

Peripherally inserted central catheters (PICCs) have long been used to provide intravenous therapy to premature neonates. The advantages of PICCs for neonates include avoidance of the pain and handling associated with repeated peripheral intravenous cannulation as well as the ability to safely deliver concentrated parenteral fluid or nutrients. Malpositioned PICC line tips can cause life-threatening complications. There are different intra- or post-procedural techniques to confirm line-tip placement to decrease the potential complications. These include plain radiographs, fluoroscopy, ultrasonographic detection, digital imaging, computed radiography, and intra-cavitary/ trans-esophageal/ and thoracic electrocardiographic monitoring. Each method has advantages and disadvantages and some methods have benefits in specific situations. The present study provides a literature review of common methods developed for detection of PICC tip positions over the last two decades.