Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter

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Background: Peripherally inserted central catheter (PICC) is an alternative to central venous cannulation. This study aimed to identify factors associated with first-attempt success rate in children undergoing PICC insertion. Methods: This retrospective study included pediatric patients who underwent PICC placement at the Children’s Hospital of Zhejiang (1/2020-12/2020). The successful puncture was defined as smooth blood return and insertion of the guide wire. Clinical data were collected, and factors associated with first-attempt success were identified by logistic regression analyses. Results: The final analysis included 640 children (360 males, 56.2%). Successful puncture at the first attempt was achieved in 380 (59.4%) patients. Multivariate logistic regression revealed that being uncooperative after sedation (OR = 2.745, 95%CI: 1.028 - 7.331, P = 0.044), being cooperative after sedation (OR = 0.318, 95%CI: 0.128–0.791, P = 0.014), target vein depth (0.5 - 1 vs. ≤ 0.5: OR = 1.715, 95%CI: 1.081–2.720, P = 0.022; 1.1-1.5 vs. ≤ 0.5: OR = 3.036, 95%CI: 1.166 - 7.903, P = 0.023; > 1.5 vs. ≤ 0.5: OR = 10.453, 95%CI: 2.366 - 46.139, P = 0.002), target vein diameter (2.0 - 2.9 vs. ≤ 2: OR = 0.313, 95%CI: 0.180 - 0.545, P < 0.001; ≥ 3 vs. ≤ 2: OR = 0.122, 95%CI: 0.055 - 0.272, P < 0.001), and 3F catheter specification (vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031) were independently associated with puncture failure at the first attempt. Conclusions: The degree of cooperation, target vein diameter and depth, and catheter specification were independently associated with the first-attempt success rate.