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Published on: March 25, 2020
Development and Temporal Validation of a Prediction Model for PICC-Related Catheter-Associated Skin Injury
Xianghong Jin1, Xiuzhu Cao1, Yidan Chen1
1Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
Objective:
To identify predictors of peripherally inserted central catheter (PICC)-related catheter-associated skin injury (CASI) and to develop and temporally validate a bedside prediction model.
Methods:
In this prospective single-centre cohort study, 1309 adults who underwent PICC insertion from June 2022 to June 2023 formed the development cohort and 568 adults enrolled from July to September 2023 formed the temporally separated validation cohort. Participants underwent prospective weekly skin assessment until PICC removal or 6 months. Candidate predictors were selected using LASSO regression with 10-fold cross-validation and the one-standard-error rule, followed by multivariable logistic regression. The final six-predictor model was assessed using bootstrap internal validation, temporal validation, calibration and decision-curve analysis.
Results:
PICC-related CASI occurred in 116 of 1309 participants (8.86%) in the development cohort and 40 of 568 (7.04%) in the validation cohort. The final model included primary tumour diagnosis (OR 3.86, 95% CI 1.30-11.50), history of catheterization (OR 5.08, 95% CI 2.67-9.67), iodophor disinfectant use (OR 0.11, 95% CI 0.05-0.25), functional dressing use (OR 0.16, 95% CI 0.06-0.41), cytotoxic drug use (OR 4.03, 95% CI 1.70-9.55) and hormonal drug use (OR 2.17, 95% CI 1.09-4.35). The optimism-corrected AUC was 0.811 in the development cohort. In temporal validation, the AUC was 0.681 (95% CI 0.610-0.743).
Conclusion:
The six-predictor model demonstrated good discrimination in the development cohort and may assist clinicians in identifying patients at high risk of PICC-related CASI. However, as a development-stage prediction model, it requires recalibration and independent multicentre external validation before being considered for routine clinical use.
Implications For Nursing Practice:
The identified predictors may help nurses recognize patients at higher risk of PICC-related CASI and support more structured skin assessment during PICC care. As the model remains at the development stage, further recalibration and multicentre external validation are needed before routine clinical use.