{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:05:10Z","timestamp":1784099110673,"version":"3.55.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peripherally inserted central catheter (PICC) is widely used for medium-to-long-term venous access, but early puncture site bleeding within 48 h remains a common complication, potentially leading to increased morbidity and healthcare costs. Identifying independent risk factors is crucial for developing targeted prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single-center, retrospective study, a consecutive cohort of patients who successfully underwent PICC insertion between March 2024 and March 2025 was enrolled. The study population was divided based on the criterion of\n                      <jats:italic>in-situ<\/jats:italic>\n                      hemorrhage into two cohorts for comparison: one with\n                      <jats:italic>in-situ<\/jats:italic>\n                      hemorrhage within 48 h post-insertion, and one without. Patient-related (demographics, comorbidities, laboratory parameters, medication history) and procedure-related factors (punctured vein, number of attempts, catheter dislodgement, etc.) were collected. Univariate analyses identified significant variables, which were subsequently entered into multivariable logistic regression models to identify independent predictors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 375 patients were included in the final analysis, with an\n                      <jats:italic>in-situ<\/jats:italic>\n                      hemorrhage incidence of 21.9%. Multivariable analysis confirmed lower fibrinogen level as an independent risk factor (OR = 0.762 per 1 g\/L increase, 95% CI: 0.583\u20130.995,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.046) and catheter advancement difficulty as a significant procedural predictor (OR = 2.560, 95% CI: 1.010\u20136.485,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.047). An unexpected association between tumor diagnosis and reduced bleeding risk was also observed (OR = 0.331, 95% CI: 0.142\u20130.768,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.011); given its counterintuitive nature and the limitations of the study design, this finding should be regarded as hypothesis-generating rather than conclusive. The number of puncture attempts showed a trend toward significance (OR = 1.661,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.060).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lower fibrinogen level and catheter advancement difficulty are independent risk factors for early PICC-related bleeding, while a tumor diagnosis appears protective. These findings highlight the importance of pre-procedural coagulation assessment and meticulous catheter placement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1836789","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:09:27Z","timestamp":1784095767000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fibrinogen and catheter advancement difficulty: unveiling the key predictors of early in-situ bleeding after peripherally inserted central catheter insertion"],"prefix":"10.3389","volume":"13","author":[{"given":"Shusheng","family":"Jiao","sequence":"first","affiliation":[{"name":"Department of Neurology, Bethune International Peace Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bethune International Peace Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianling","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Bethune International Peace Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxia","family":"Zhi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bethune International Peace Hospital, Shijiazhuang","place":["Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2450572","DOI":"10.1080\/16078454.2025.2450572","article-title":"Outcomes of peripherally inserted central catheter vs conventional central venous catheters in hematological cancer patients: a systematic review and 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