Risk Factors for Unexpected Removal of Peripherally Inserted Central Catheters and Proper Duration of the Catheter Maintenance

Abstract

Purpose: Despite the advantages of a peripherally inserted central catheter (PICC), many complications have led to the unexpected removal of catheters. On the other hand, there are no guidelines for the duration of PICC maintenance. This study analyzed the risk factors for the unexpected removal of PICC to suggest guidelines for the duration of catheter maintenance. Materials and Methods: Among 520 patients who underwent PICC insertion from January 2014 to December 2015, 407 were included. Unexpected removal was observed in 95 patients. Univariate and multivariate analyses were performed to evaluate the risk factors for unexpected removal. The changing pattern of the probability of unexpected removal was analyzed by change point analysis. Results: Malignancy (OR=4.498, 95% CI=2.49∼8.125) and ICU hospitalization (OR=4.218, 95% CI=1.694∼10.505) were significant risk factors for the unexpected removal of PICC. The left arm (OR=0.279, 95% CI=0.143∼0.544) and basilic vein (OR=0.323, 95% CI=0.192∼0.545) were associated with a lower probability of unexpected removal compared to the right arm and brachial vein, but selection bias could exist in the arm side and vein. Change-point analysis revealed a rapid increase in the probability of unexpected removal after 54 catheter days. Conclusion: This study suggests the removal or exchange of PICC before 54 catheter days to minimize serious complications. More attention is needed for patients with malignancies and ICU stays. (Surg Metab Nutr 2020;11:27-33)