Effects of two securement methods on peripherally inserted central catheter stability and skin integrity in very low birth weight infants: a retrospective study.

BACKGROUND: Very low birth weight infants often require peripherally inserted central catheter (PICC) for long-term venous access. Conventional securement methods are associated with high rates of catheter dislodgement and skin injury, but the clinical effectiveness and cost-effectiveness of modified combination securement methods remain insufficiently validated. This study aimed to investigate the effects of a novel combination securement method on catheter dislodgement and skin injury in very low birth weight infants (VLBWIs) undergoing PICC placement, and to perform a cost-effectiveness analysis to inform evidence-based selection of the optimal securement strategy. METHODS: This retrospective, single-center analysis comprised 181 VLBWIs who underwent PICC placement in the neonatal intensive care unit (NICU) between January 2018 and December 2025. Infants were assigned to either a conventional securement group (conventional group) or a modified combination fixation group (modified group), the latter consisting of four steps: pressure relief protection, tension-free fixation, buffer reinforcement, and sealing coverage (termed 'protection-pressure reduction-fixation-sealing'). A 1:1 nearest-neighbor propensity score matching (PSM) approach was used to balance baseline confounders. After matching, clinical outcomes and direct medical costs were compared between groups, and correlations between cost metrics and clinical outcomes were analyzed. RESULTS: Following matching, baseline characteristics were well balanced between groups, with no significant differences (all P>0.05). The modified group showed significantly lower rates of unplanned PICC removal and skin injury than the conventional group (P=0.02 and P<0.001, respectively). Logistic regression identified the modified securement method as an independent protective factor against unplanned PICC removal in VLBWIs [odds ratio (OR) =0.275, P=0.005]. Moreover, total direct medical cost per PICC placement was significantly lower in the modified group (P<0.001). CONCLUSIONS: The modified combination securement method significantly improves clinical outcomes associated with PICC placement in VLBWIs, reduces complication rates, and achieves overall cost savings. Offering both clinical and economic benefits, this approach warrants widespread adoption in the NICU.