The applications, complications, and management of neonatal peripherally inserted central catheters (n-PICCs): a narrative review.

The neonatal peripherally inserted central catheters (n-PICCs) is a commonly used vascular access device in neonatal intensive care, yet its associated complications significantly affect patient outcomes. This narrative review aims to summarize current status of n-PICCs, major complications and risk factors, and evidence-based preventive strategies. A literature search was conducted in PubMed, Web of Science, and Embase for articles published between January 2000 and February 2026, and relevant studies were synthesized and discussed. The findings demonstrate that the incidence of n-PICCs-related complications ranges from 10% to 40%, encompassing catheter-related bloodstream infection, thrombosis, cardiac tamponade, and mechanical failure. Key risk factors include low birth weight, small gestational age, prolonged catheter dwell time, malposition of the catheter tip, and improper insertion site selection. In terms of preventive strategies, interventions such as ultrasound guidance, intracavitary electrocardiography, antimicrobial-impregnated catheters, tissue adhesive securement, and bundle care strategies have been associated with reductions in specific complications in observational and quasi-experimental studies, although the evidence quality varies, while specialized vascular access teams and standardized training serve as important foundations for ensuring procedural quality and patient safety. Based on these findings, this review proposes that neonatal vascular access management should shift from single-intervention approaches toward system-based frameworks. Integrating technical optimization, material selection, standardized procedures, and organizational management into a comprehensive safety system covering the full process-assessment, insertion, maintenance, removal, and monitoring-represents a key pathway for reducing complications and ensuring patient safety. Future research should focus on multicenter randomized controlled trials, improving risk prediction models, and advancing the clinical application of intelligent monitoring technologies and evidence-based practice dissemination.