**Background:** Umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs) are commonly used in preterm infants to establish secure central vascular access for parenteral nutrition and medications. However, these catheters are associated with serious complications including bloodstream infection, thrombosis, organ injury, and cardiac arrhythmias. Controversy surrounds the optimal dwell time for UVCs, with the CDC recommending removal as soon as possible but allowing use up to 14 days. The authors performed a survey to assess current practice and complication rates in very low birth weight infants (<1250 g) to inform sample size calculations for a planned multicenter randomized controlled trial.
**Methods:** An electronic survey was distributed to senior neonatologists at all 20 level I NICUs participating in the NeoVitaA trial in Austria and Germany. The survey assessed frequency of UVC/PICC use, lumen type, dwell time, use of standardized operating procedures, anticoagulation use, imaging methods for catheter positioning, and rates of catheter-related complications including bacterial infection, thrombosis, emboli, organ injury, cardiac arrhythmia, and dislocation. Data collection was at the discretion of participating centers, using local data sources, German Neonatal Network data, or expert opinion when necessary. Clinical sepsis was defined as at least two signs of systemic inflammatory response plus one laboratory sign and decision to treat with anti-infective drugs for at least 5 days. Blood culture-confirmed sepsis required detection of a pathogen in blood culture.
**Key Results:** The response rate was 60% (12/20 centers). Eleven of 12 centers declared intent to participate in the upcoming RCT. More than 75% of NICUs used SOPs for catheter management. PICCs were used more frequently than UVCs, with 58.3% of centers using PICCs in ≥75% of eligible infants versus 25% for UVCs. X-ray was the primary imaging method for catheter positioning (100% for PICCs, 41.7% exclusively for UVCs). UVC dwell time ranged from 1–10 days, while PICC dwell time extended up to >10 days. Reported complication rates for UVCs (dwell time 1–10 days) were: bacterial infection 4.2±3.4% (range 0–10%), thrombosis 7.3±7.1% (0–20%), emboli 0.9±2.0% (0–5%), organ injury 1.1±1.9% (0–5%), cardiac arrhythmia 2.2±2.5% (0–5%), and dislocation 5.4±8.7% (0–30%). For PICCs (dwell time 1–14 days): bacterial infection 15.0±3.4% (range 2.5–30%), thrombosis 4.3±3.5% (0–10%), emboli 0.8±1.6% (0–5%), organ injury 1.5±2.3% (0–5%), cardiac arrhythmia 1.5±2.3% (0–5%), and dislocation 8.5±4.6% (0–30%). Correct position at first attempt was 58.2±15.9% for UVCs and 56.4±3.5% for PICCs. A wide range between centers was noted for all complication rates.
**Clinical Implications:** The reported complication rates were higher than previously published, with PICC-associated infection rates substantially exceeding those for UVCs (15.0% vs 4.2%). The authors suggest that when central venous access is needed in the early postnatal period, initiating with a UVC may be prudent. The higher PICC complication rates may relate to technical insertion difficulties, timing, and longer dwell times. Based on these findings and preliminary pilot data, the authors plan a multicenter RCT (UVC—You Will See) enrolling 562 infants with birth weight <1250 g and/or gestational age <30 weeks to compare early planned UVC removal (1–5 days) versus later removal (6–10 days). The primary outcomes will include catheter-related bloodstream infection, thrombosis/emboli, and organ injury. A longer dwell time could reduce the need for additional catheter insertions, painful procedures, radiographs, antibiotic use, and costs. Study limitations include potential selection bias (only 20 NICUs contacted, 60% response rate), retrospective data collection, and lack of fully standardized data extraction, which may introduce both under- and over-reporting.