Occurrence and Risk Factors for Unplanned Central Venous Catheter Removal in Critically Ill Patients: A Multicenter Cohort Study.

Abstract

Background: Central venous catheters (CVCs) are crucial for critically ill patients but pose risks of complications and unplanned removal, which can interrupt treatment, prolong hospital stays, and increase mortality. This investigation sought to examine the occurrence and risk factors for unplanned CVC removal among intensive care patients in China. Methods: A multicenter cohort study was conducted across 22 public tertiary hospitals throughout China, from September 4, 2023, to February 29, 2024, enrolling critically ill patients with CVCs. Cox proportional hazards regression models were used to assess the risk factors for unplanned CVC removal. Results: The study comprised a total of 2680 first-time CVC insertion events (one per patient) in critically ill patients. 1151 (42.95%) CVCs were removed; most (n = 832, 31.04%) were elective. A total of 153 CVCs were removed prematurely (5.71%; 95% CI: 4.84-6.68), and infection-related complication was the leading cause (n = 124, 4.63%; 95% CI: 3.85-5.50; 5.26 per 1000 CVC days). Independent risk factors included male gender (HR, 2.04; 95% CI: 1.40-2.99; p < 0.001), neurological disorders (HR, 2.41; 95% CI: 1.50-3.86; p < 0.001), and mechanical ventilation (HR, 1.71; 95% CI: 1.09-2.70; p=0.02), while urgent insertion reduced the risk (HR, 0.52; 95% CI: 0.29-0.92; p=0.02). In subgroup analysis, diagnosis with neurological disorders (HR, 2.31; 95% CI 1.40-3.81, p=0.001), and urgent CVC insertion (HR, 0.41; 95% CI 0.21-0.82, p=0.01) were significantly associated with unplanned CVC removal in males but not in females (p > 0.05). No significant interactions were found between gender and diagnosis, mechanical ventilation, or urgent insertion (all p > 0.05). Conclusions: Unplanned CVC removal occurred in 5.71% of cases, primarily due to infection. Identified risk factors (male gender, neurological disorders, and mechanical ventilation) and protective factors (urgent insertion) highlight targets for preventive strategies in critical care.