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Femoral Arterial and Venous Catheterization for Blood Sampling, Drug Administration and Conscious Blood Pressure and Heart Rate Measurements
Published on: January 24, 2012
Fibrinogen and catheter advancement difficulty: unveiling the key predictors of early in-situ bleeding after
Shusheng Jiao1, Hongjie Yang2, Jianling Yang3
1Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China.
Insights
Early bleeding after peripherally inserted central catheter (PICC) placement is linked to lower fibrinogen levels and difficult catheter insertion. Tumor diagnosis may reduce bleeding risk, warranting further investigation.
Area of Science:
- Vascular Access
- Medical Complications
- Patient Safety
Background:
- Early puncture site bleeding within 48 hours of peripherally inserted central catheter (PICC) placement is a common complication.
- This complication can increase patient morbidity and healthcare expenses.
- Identifying risk factors is essential for effective prevention strategies.
Purpose of the Study:
- To identify independent risk factors for early bleeding complications following PICC insertion.
- To analyze patient-related and procedure-related factors associated with post-PICC bleeding.
Main Methods:
- A retrospective study of 375 patients undergoing PICC insertion.
- Patients were divided into two groups: those with and without hemorrhage within 48 hours.
- Multivariable logistic regression was used to identify independent predictors of bleeding.
Main Results:
- The incidence of early post-PICC hemorrhage was 21.9%.
- Lower fibrinogen levels (OR = 0.762) and difficulty during catheter advancement (OR = 2.560) were independent risk factors for bleeding.
- Tumor diagnosis showed a protective association (OR = 0.331), though this finding requires further research.
Conclusions:
- Lower fibrinogen levels and challenging catheter advancement are significant predictors of early PICC-related bleeding.
- The potential protective effect of a tumor diagnosis warrants further investigation.
- Pre-procedural coagulation assessment and careful catheter manipulation are crucial for minimizing bleeding risk.
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.
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