In neonatal intensive care, securing reliable vascular access is only part of the challenge. For many preterm and critically ill infants, intravenous therapy may continue for weeks or even months, making preservation of the vascular system a key consideration throughout their treatment journey.
The concept of vessel preservation focuses on protecting venous health, reducing avoidable vessel trauma, and maintaining future access options. While insertion technique, maintenance practices and device selection all contribute to this goal, one factor that is often overlooked is catheter material.
The material used to manufacture a peripherally inserted central catheter (PICC) can influence its mechanical performance, durability and interaction with the vessel wall, all of which may have implications for vessel preservation strategies in neonatal care.
The Role of Catheter Material
Historically, silicone and polyurethane have been the most widely used materials for PICCs. Both materials have demonstrated clinical utility, but they possess different mechanical characteristics that may influence catheter performance.
Silicone is valued for its softness and biocompatibility. However, it typically requires thicker catheter walls to achieve adequate strength. Polyurethane, by contrast, offers greater tensile strength and resistance to mechanical stress, allowing manufacturers to produce thinner-walled catheters while maintaining lumen size. Studies comparing silicone and polyurethane PICCs have identified differences in rates of catheter-related complications, particularly those associated with mechanical performance.¹
Whilst material selection should never be considered in isolation, these characteristics may support several key objectives of vessel preservation.
Catheter-to-Vein Ratio and Venous Preservation
One of the most important considerations in neonatal vascular access is the relationship between catheter size and vessel diameter.
A catheter occupying too great a proportion of the vessel lumen may reduce blood flow around the device and increase the risk of endothelial irritation, thrombosis and catheter-related complications. Consequently, contemporary vascular access practice increasingly emphasises the importance of maintaining an appropriate catheter-to-vein ratio.
In neonatal patients, where veins are inherently small, even minor differences in catheter dimensions may be clinically significant.
The ability to manufacture strong, thin-walled catheters may therefore contribute to vessel preservation strategies by supporting the use of devices with smaller external diameters whilst maintaining the lumen required for therapy.
Mechanical Performance and Catheter Longevity
From a vessel preservation perspective, maintaining catheter function is as important as achieving successful insertion.
Catheter failure resulting from rupture, kinking, occlusion or accidental dislodgement frequently necessitates replacement procedures. Each replacement exposes the infant to additional handling, procedural risks and potential vessel trauma.
Modern polyurethane materials have been developed to provide increased resistance to stretching, rupture and kinking while remaining sufficiently flexible for use in small vessels. Improved mechanical durability may help support longer catheter survival and reduce the frequency of unplanned device replacement.
Although multiple factors contribute to catheter longevity, material performance represents one component of maintaining reliable access over prolonged treatment periods.
Supporting a Vessel Health Strategy
Vessel preservation should not be viewed as a device-specific initiative. Rather, it is a clinical framework that considers the entire vascular access pathway.
Key elements include:
- Early assessment of anticipated therapy requirements
- Selection of the most appropriate vascular access device
- Consideration of catheter-to-vein ratio
- Use of ultrasound to support vessel assessment and insertion
- Accurate tip positioning
- Effective catheter securement
- Evidence-based maintenance practices
- Ongoing surveillance for complications
Within this framework, catheter material contributes to overall device performance but should be considered alongside wider patient, vessel and therapy-related factors.
Looking Ahead
As neonatal vascular access practice continues to evolve, there is increasing recognition that successful outcomes extend beyond obtaining central access. The ability to preserve venous health, minimise vessel injury and maintain future access options is becoming an equally important measure of quality.
Advances in catheter materials have enabled the development of devices designed to support these objectives, particularly through improvements in mechanical strength and catheter profile. Whilst no single factor determines PICC success, understanding how material characteristics influence performance can help inform device selection within a broader vessel preservation strategy.
Conclusion
The principles of vessel preservation are becoming increasingly central to neonatal vascular access practice. In patients with limited venous resources and prolonged treatment needs, every vascular access decision has implications beyond the immediate episode of care.
Catheter material is one factor that can influence PICC performance through its effects on catheter profile, mechanical durability and long-term functionality. When considered as part of a comprehensive vessel health approach, these characteristics may contribute to protecting venous access and supporting ongoing therapy throughout an infant’s NICU journey.
References and supporting materials
- Seckold TL, Walker S, Dwyer T. A comparison of silicone and polyurethane PICC lines and postinsertion complication rates: a systematic review. J Vasc Access. 2015;16(3):167-177.
- Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion Therapy Standards of Practice. J Infus Nurs. 2021;44(1S Suppl 1):S1-S224.
- Sharp R, Cummings M, Fielder A, Mikocka-Walus A, Grech C, Esterman A. The catheter-to-vein ratio and rates of symptomatic thrombosis in patients with PICCs: a systematic review. J Vasc Access. 2015;16(3):167-176.
- Yang L, Fan Q, Fan L, Qiu J. The applications, complications, and management of neonatal peripherally inserted central catheters (n-PICCs): a narrative review. Front Pediatr. 2026;14.
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