Peripherally inserted central catheter-related complications: A national prospective multicenter study of incidence, risk factors and outcomes in China

OBJECTIVE: We aimed to assess the incidence, risk factors, and outcomes of PICC-related complications in China. DESIGN, SETTING, AND PARTICIPANTS: This prospective multicenter cohort study was performed at 60 hospitals located in 30 cities in 7 provincial-level region throughout China. The primary outcome was a composite of PICC-related complications (catheter dislodgement, catheter occlusions, catheter-associated skin injuries (CASIs), catheter-related thrombosis (CRT), central line-associated bloodstream infections (CLABSIs), catheter malposition, catheter fracture, phlebitis, and drainage from the catheter or insertion site). Cox regression was used to investigate the risk factors for PICC-related complications. RESULTS: Among 7321 included participants, the mean (SD) patient age was 56.4 (14.2) years, and 4468 patients (61.06%) were female. The incidence of PICC-related complications was 15.47% (1133/7321), among which catheter dislodgement was the most common (4.69%), followed by catheter occlusions (3.73%), and CASIs (3.25%). The incidence of complications did not fluctuate throughout the entire indwelling period. Unplanned catheter removal occurred in 546 patients, representing a low overall unplanned removal rate of 7.46% (546/7321). However, this accounted for 48.19% of the 1133 patients who developed complications. Multivariable analyses identified risk factors for the three catheter-related complications. Higher body mass index (BMI) increased dislodgement risk (HR 1.04), female sex was protective against dislodgement (HR 0.62), and elevated D‑dimer and prior thrombosis were associated with catheter occlusions. Multiple catheter advancement attempts and insertion indications were independently associated with both occlusions and skin injuries; non‑dominant arm insertion was associated only with occlusions. CONCLUSION: The overall incidence of PICC-related complications was 15.47%, with a 7.46% unplanned removal rate. Notably, 48.19% of these complications necessitated unplanned removal. Specific patient characteristics and clinical variables were identified as independent risk factors for the primary complications. Implementing targeted, evidence-based management strategies based on modifiable factors may mitigate the risk of adverse events and improve patient safety.