Ultrasound-Guided Non-Tunneled Centrally Inserted Central Catheters versus Peripherally Inserted Central Catheters in Neonates under 1,000 Grams: A Comparative Cohort Study.

Abstract

Introduction: Peripherally inserted central catheters (n-PICCs) are standard in neonatal intensive care but carry high complication rates. Ultrasound-guided non-tunneled centrally inserted central catheters (nT-CICCs) offer a potential alternative. This study compared outcomes of nT-CICCs versus n-PICCs in extremely low birth weight (ELBW) neonates.

Methods: This is a single-center, comparative cohort study (April 2022-October 2025) enrolling neonates <1,000 g requiring central venous access. A retrospective cohort receiving n-PICCs was compared with a prospective cohort receiving nT-CICCs. The primary outcome was central line-associated bloodstream infection (CLABSI) density rate on successfully placed catheters. Secondary outcomes included procedural success, mechanical complications, and risk factors for CLABSI.

Results: We analyzed 103 catheter insertions (50 nT-CICCs, 53 n-PICCs). Procedural success was 100% for nT-CICCs and 94% for n-PICCs (3 immediate failures excluded from follow-up). Among 100 indwelling catheters, nT-CICCs showed significantly lower CLABSI rates (1.83 vs. 11.09 per 1,000 catheter-days; p = 0.038). Overall complications affected 4% of the nT-CICC group versus 64% of the n-PICC group (p < 0.001). nT-CICCs enabled therapy completion in 66% of cases compared with 12% for n-PICCs. Catheter type was the sole independent predictor of CLABSI (adjusted HR 7.1, 95% CI: 1.01-49.74; p = 0.048).

Conclusions: Ultrasound-guided nT-CICCs are associated with significantly lower rates of infectious and mechanical complications compared with n-PICCs in ELBW neonates. This approach provides a safer and more durable option for central venous access in this vulnerable population.