Prospective Study of Interventional Radiology-Guided PICC Insertions in Oncology Patients: Incidence and Risk Factors for Complications in an LMIC Cohort

To prospectively assess the incidence, types, and risk factors for complications following interventional radiology–guided peripherally inserted central catheter (PICC) placement in adult cancer patients at a lower-middle-income-country tertiary center. In this single-center prospective cohort, all cancer patients ≥14 years who received a 4 Fr single-lumen PICC under ultrasound guidance with fluoroscopic tip confirmation were followed until line removal. Weekly structured follow-up (in-person or telephonic) was conducted. Complications were recorded using predefined criteria. Associations with demographic, clinical, and procedural factors were analyzed using chi-square/Fisher's exact or t/Mann–Whitney U tests. Fifty-six PICCs were placed in 48 patients (50% female; 28 solid and 28 hematologic cancers), contributing 4,386 catheter-days (median dwell time: 54 days). Twenty-five lines (44.6%) developed complications (32 events; 7.3/1,000 catheter-days). The most frequent were occlusion (17.9%; 2.3/1,000 days), catheter-related bloodstream infection, defined clinically rather than culture-confirmed (12.5%; 1.6/1,000 days), dislodgement (10.7%), and break/leak (10.7%). No symptomatic deep vein thrombosis (DVT) occurred. Complications led to premature removal in 21 lines (37.5%), with an 87.5% device-loss rate among affected catheters. Mean dwell time was significantly longer in lines with complications (103.6 vs. 57.9 days; p = 0.021). Higher body mass index showed a trend (p = 0.053), but other factors, including age, cancer type, puncture attempts, and tip position, were not associated with complication rates. PICC complications remain common despite imaging guidance and are driven chiefly by prolonged dwell time and patient factors, not insertion technique. Mechanical problems (including occlusion, dislodgement, and breakage) and catheter-related infections were the most common complications, and no symptomatic DVT was observed, although subclinical events could not be excluded.