Risk Factors for Early PICC Removal: A Retrospective Study of Adult Inpatients at an Academic Medical Center

Abstract

BackgroundUse of PICCs has been rising since 2001. They are used when long-term intravenous access is needed and for blood draws in patients with difficult venous access.ObjectiveTo determine which risk factors contribute to inappropriate PICC line insertion defined as removal of a PICC within five days of insertion for reasons other than a PICC complication.DesignRetrospective, observational study.SettingTertiary-care, Level 1 trauma center.PatientsAdult patients with a PICC removed 1/1/2017 to 5/4/2020.MeasurementsFrequency of PICC removal within five days of insertion and associated risk factors for early removal.ResultsBetween 1/1/17 and 5/4/2020, 995 of 5348 PICCs inserted by the IV nursing team were removed within five days (19%). In 2017, 5 of 429 PICCs developed a central line-associated infection (1.2%) and 29 of 429 PICCs developed symptomatic venous thromboembolism (6.7%). Patients with PICCs whose primary service was a medical subspecialty were independently at higher risk of early removal (OR 1.44, 95% CI 1.14, 1.83); weekday insertion was independently associated with a lower likelihood of early removal compared to weekend insertion (OR 0.60; 95% CI 0.49, 0.75).LimitationPICC removal after discharge was not assessed and paper records were likely incomplete and biased.ConclusionNearly one in five PICCs were removed within five days. Patients whose primary team was a medical subspecialty were at independently higher risk of early removal.