factors associated with successful first-attempt puncture in pediatric patients undergoing ultrasound-guided peripherally inserted central catheter

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.