Evaluation of Superficial Femoral Vein Access for Peripherally Inserted Central Catheters in Neonates, Infants, and Children

Abstract

Clinical Relevance: Uses patient data to reflect practice and guide clinicians. Safety Profiling: Identifies complication rates for this access route. Practice Optimization: Informs protocols and supports evidence‑based decisions. Peripherally inserted central catheters (PICCs) are essential for prolonged intravenous therapy in neonates and pediatric patients. While upper extremity PICC placement is traditionally preferred in older children and adults, anatomical and clinical factors may favor lower extremity placement in neonates and young children. To evaluate the safety, efficacy, and outcomes of ultrasound-guided superficial femoral vein (SFV) PICC placement in hospitalized neonates, infants, and children. We conducted a retrospective review of 1427 patients who underwent SFV PICC placement between July 2020 and June 2025. Data included patient demographics, procedural details, success rates, complications, and catheter outcomes. Overall success rate was 96%, with first-attempt success of 86%. Mean vein diameter was 2.2 mm (SD = 0.40). Catheter-related deep vein thrombosis occurred in 3.1% of insertions; 66.7% of affected patients received anticoagulation. Central line-associated bloodstream infection incidence was 0.065 per 1000 catheter days, lower than the hospital-wide rate (0.153). Most catheters were removed upon therapy completion; common premature removal causes included tip migration and occlusion. Mean dwell time was 16.7 days (range, 0–117). Ultrasound-guided SFV PICC placement with a midthigh exit site is a safe and effective alternative to upper extremity access in neonates, infants, and pediatric patients when appropriate insertion bundles and techniques are used. Proactive strategies for securement and growth-related monitoring are essential to optimize outcomes and minimize complications.