Fibrinogen and catheter advancement difficulty: unveiling the key predictors of early in-situ bleeding after peripherally inserted central catheter insertion.

BACKGROUND

Peripherally inserted central catheter (PICC) is widely used for medium-to-long-term venous access, but early puncture site bleeding within 48 h remains a common complication, potentially leading to increased morbidity and healthcare costs. Identifying independent risk factors is crucial for developing targeted prevention strategies.

METHODS

In this single-center, retrospective study, a consecutive cohort of patients who successfully underwent PICC insertion between March 2024 and March 2025 was enrolled. The study population was divided based on the criterion of in-situ hemorrhage into two cohorts for comparison: one with in-situ hemorrhage within 48 h post-insertion, and one without. Patient-related (demographics, comorbidities, laboratory parameters, medication history) and procedure-related factors (punctured vein, number of attempts, catheter dislodgement, etc.) were collected. Univariate analyses identified significant variables, which were subsequently entered into multivariable logistic regression models to identify independent predictors.

RESULTS

A total of 375 patients were included in the final analysis, with an in-situ hemorrhage incidence of 21.9%. Multivariable analysis confirmed lower fibrinogen level as an independent risk factor (OR = 0.762 per 1 g/L increase, 95% CI: 0.583-0.995, p = 0.046) and catheter advancement difficulty as a significant procedural predictor (OR = 2.560, 95% CI: 1.010-6.485, p = 0.047). An unexpected association between tumor diagnosis and reduced bleeding risk was also observed (OR = 0.331, 95% CI: 0.142-0.768, p = 0.011); given its counterintuitive nature and the limitations of the study design, this finding should be regarded as hypothesis-generating rather than conclusive. The number of puncture attempts showed a trend toward significance (OR = 1.661, p = 0.060).

CONCLUSION

Lower fibrinogen level and catheter advancement difficulty are independent risk factors for early PICC-related bleeding, while a tumor diagnosis appears protective. These findings highlight the importance of pre-procedural coagulation assessment and meticulous catheter placement.