Objective:

To identify and analyze factors associated with puncture site bleeding within 48 hours of PICC insertion.

Approach:

• Study Design: A single-center, retrospective observational study was conducted, analyzing a cohort of patients who underwent PICC insertion.
• Data Collection: Patient-related and procedure-related factors were collected and analyzed to identify significant predictors of bleeding.
• Statistical Analysis: Univariate analyses were performed followed by multivariable logistic regression to identify independent risk factors.

Key Findings:

• In-situ hemorrhage incidence was 21.9% among 375 patients.
• Lower fibrinogen levels were identified as an independent risk factor for bleeding (OR = 0.762 per 1 g/L increase, 95% CI: 0.583–0.995, p = 0.046).
• Catheter advancement difficulty was also a significant predictor of bleeding (OR = 2.560, 95% CI: 1.010–6.485, p = 0.047).
• A tumor diagnosis was unexpectedly associated with a reduced risk of bleeding (OR = 0.331, 95% CI: 0.142–0.768, p = 0.011).
• The number of puncture attempts showed a trend toward significance (OR = 1.661, 95% CI: 0.999–2.750, p = 0.060).

Interpretation:

Lower fibrinogen levels and catheter advancement difficulty are significant predictors of early bleeding following PICC placement.

Limitations:

• The study design is retrospective, which may introduce bias.
• The association between tumor diagnosis and reduced bleeding risk is counterintuitive and should be considered hypothesis-generating.

Conclusion:

Lower fibrinogen levels and catheter advancement difficulty are independent risk factors for early PICC-related bleeding.