Ultrasound-guided tip location and detection of tip migration of neonatal peripherally inserted central catheters: a prospective, multicenter study (DISLOTIP study)

Background: Incorrect neonatal peripherally inserted central catheter (n-PICC) tip positioning and secondary migration lead to serious complications. Identifying an accurate and non-invasive tip location method is crucial. This study primarily aimed to evaluate the feasibility of ultrasound-guided n-PICC tip location in a multicenter setting. Secondary aims were to determine the incidence and timing of tip migration and to identify factors associated with migration. Methods: Multicenter, prospective, cross-sectional study conducted at 10 Neonatal Intensive Care Units from January 2024 to January 2025. Ultrasound was used to confirm initial tip placement (T0) and repeated at 60–120 min (T1), 48–72 h (T2), and 6–8 days (T3) while the neonate was maintained in a standardized position. Feasibility was defined as obtaining clear images of all protocol-specified ultrasound views. Migration was defined as a tip displacement ≥ 0.5 cm or as a location in a different vessel. To analyze the factors associated with migration, univariate and multivariable logistic regression models were used. Results: Two hundred nineteen n-PICCs in 205 neonates were investigated. Ultrasound tip location was feasible in 212/219 (97%) cases. Tip migration occurred in 90/207 (43%) catheters evaluated for migration. The majority of migrations (79/90, 88%) were towards the heart and frequently occurred within the first 2 h post-insertion. Intracardiac migration was significantly more common when catheters were inserted via the upper extremities or scalp (79/87, 90%) compared to those placed via the lower extremities (0/14, 0%; p = 0.001). While univariate analysis linked migration to lower body weight and insertion site, multivariable analysis confirmed only the insertion site as an independent predictor, with non-upper limb insertions showing significantly lower odds of migration compared to those distal to the elbow. Conclusions: Ultrasound is a highly feasible and accurate method for n-PICC tip location. Tip migration is a frequent event, particularly towards the heart in upper limbs/scalp insertions and within the first 2 h. We recommend serial ultrasound monitoring to detect tip migration and potentially reduce catheter-related complications. Trial registration: ClinicalTrials.gov Identifier: NCT06438289. Registered 24 May 2024.