Establishing peripherally inserted central catheter service in a middle-income country and risk factors for catheter...

Literature describing the characteristics and outcomes of peripherally inserted central catheter (PICC) in middle-income countries remained limited. The primary objective of this study was to determine the incidence of catheter failure. The secondary objectives were to describe the characteristics and complications of PICC placement, and to identify risk factors associated with catheter failure.

This retrospective study was conducted at a tertiary care center in Thailand. Patients who underwent PICC placement by the Anesthesiology Line Service Team between January 2023 and August 2024, were included. Data collection included patient characteristics, procedural details, and post-insertion care. Reasons for removal were considered appropriate if the catheter remained functional until the end of treatment or the patient's death; otherwise, removal due to complications was classified as catheter failure.

A total of 905 patients received 1038 PICCs, accounting for 43,925 catheter-days. The median catheter dwell time was 21 days (IQR 11-45). The incidence of catheter failure was 22.4% (232 catheters; 95% CI, 19.9%-24.9%). The most common complications leading to catheter removal were central line-associated blood stream infection (7.7%), catheter breakage (3.7%), and catheter dislodgement (3.6%). The most frequent complication during PICC maintenance was catheter occlusion (22.2%). Independent risk factors for catheter failure included pediatric patients (adjusted odds ratio (aOR) 2.312; 95% CI 1.2105-4.436), prolonged intravenous medication (aOR 1.717; 95% CI 1.083-2.720), chemotherapy (aOR 1.846; 95% CI 1.107-3.078), procedural time >60 min (aOR 2.037; 95% CI 1.081-3.841), and catheter duration >3 weeks (aOR 1.626; 95% CI 1.172-2.254).

The incidence of catheter failure (22.4%) and other complications during PICC maintenance (28.0%) was higher than modern optimized vascular access program. Recognition of common complications and risk factors leading to PICC removal highlights the need for targeted surveillance and post-insertion care to improve PICC outcomes.