Prediction Models for Unplanned Removal of Peripherally Inserted Central Catheters and Their Risk Factors: A Narrative Review

Background: While peripherally inserted central catheters (PICCs) are widely used for medium- to long-term venous therapies, complications such as infection, venous thrombosis, occlusion, and dislodgement frequently lead to unplanned removal before treatment completion. This review aimed to describe prediction models for unplanned PICC removal and its precipitating complications in adults, focusing on their methodological characteristics, retained predictors, and the extent of external validation.Methods: This narrative review followed a structured literature search across PubMed, Scopus, and Google Scholar for articles published from database inception to August 2026, using keywords related to PICCs, unplanned removal, complications, risk factors, and prediction models in adults. Studies were categorized according to whether the predicted outcome was unplanned removal itself or a precipitating complication, and were narratively synthesized.Results: Fourteen prediction-model studies were included; 3 predicted removal itself and 11 predicted a removal-precipitating complication, most commonly venous thrombosis. The predictors retained in the final models were distributed multidimensionally across the patient, catheter, and treatment/management domains; elevated D-dimer, a history of venous thromboembolism, and the number of catheter lumens recurred most consistently, whereas the direction of catheter material and valve type was inconsistent between models that used different outcome definitions. None of the three models targeting removal itself retained the number of lumens, all three were developed in single centers, and only one was externally validated.Conclusions: The value of predictors and prediction models is realized through risk-based monitoring; because much of this monitoring is performed by nurses, integrating catheter placement, prediction models, and risk-factor-based patient monitoring into the nursing workflow is proposed as a direction for future research and practice. No included study evaluated the clinical effect of such integration, which therefore remains to be demonstrated.