Safety and feasibility of peripherally inserted central catheter (PICC) placement in patients with newly diagnosed acute leukemia: A single-center retrospective study

Patients with newly diagnosed acute leukemia are at increased risk of bleeding during vascular access because of thrombocytopenia and coagulopathy. The primary objective of this single-center retrospective study (November 2023–August 2024; Ruijin Hospital) was to evaluate the feasibility and safety of a peripherally inserted central catheter (PICC) puncture and nursing protocol incorporating ultrasound-guided Seldinger puncture, controlled sheath withdrawal with gauze-assisted compression, and localized hemostatic dressing in 101 patients prior to chemotherapy. The first-attempt success rate was 95.1%. At 24 h, active oozing occurred in 14 patients (13.9%); all events were CTCAE grade 1–2 and were controlled with local measures. Platelet count (PLT; OR = 0.972, P = 0.029) and fibrinogen (Fg; OR = 0.594, P = 0.049) were independent predictors of bleeding. On ROC analysis, PLT showed greater predictive value (AUC = 0.762, 95% CI 0.628–0.880). Catheter malposition and thrombosis each occurred in 1.0% of patients (CTCAE grade 2 and grade 1, respectively); no phlebitis, catheter-related infection, or grade ≥ 3 adverse events were reported. The technique was safe and feasible, and PLT and Fg helped predict bleeding risk. Prospective multicenter validation is warranted.