ArticleFrontiers in pediatrics2026
Effect of a prevention bundle for internal jugular vein malposition of peripherally inserted central catheters in children: a single-center before-after study.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Peripherally inserted central catheters (PICCs) are widely used in pediatric intensive care units, but bedside insertion without fluoroscopy often results in catheter tip malposition into the internal jugular vein (IJV). We implemented a three-component prevention bundle consisting of head rotation toward the insertion side, arm abduction, and neck ultrasonography confirmation of the guidewire, and evaluated its effect on IJV catheter malposition. Methods: This before-after study was performed on patients aged <16 years who underwent PICC placement during the pre- and post-bundle periods. The primary analysis compared IJV catheter malposition between the pre-bundle and fully adherent post-bundle groups. Secondary analysis evaluated adherence to individual bundle components and their association with IJV catheter malposition. Results: We compared 168 pre-bundle patients with 112 fully adherent post-bundle patients. The IJV catheter malposition rate decreased from 11.9% (20/168) to 6.3% (7/112). However, this reduction was not statistically significant ( Conclusions: The effect of bundle implementation was limited. A simpler, more reliable bundle should be investigated.
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