Background: Difficult intravenous access is a common challenge in patients with obesity, often resulting in placement of peripherally inserted central catheters (PICCs). However, little is known about the relationship between obesity and the risk of device-related complications in patients with PICCs. We sought to assess associations between obesity and PICC-related complications in hospitalized medical patients.
Methods: From January 2013 to November 2023, professional abstractors collect patient-level data on a sample of PICC insertions at 69 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). We classified patients using the following basal metabolic index (BMI) categories: underweight (BMI < 18.5), normal (BMI 18.5-24.9), overweight (BMI 25-29.9), and obesity (BMI ≥30). We compared patient, clinician, and device characteristics of patients with obesity and those with normal BMI, using Chi-square test for categorical variables and Student’s T-test for continuous variables. Primary outcome was any major device complication (i.e., central line-associated bloodstream infection (CLABSI) or catheter-related venous thromboembolism (CR-VTE)). Secondary outcomes included any minor device complication (i.e., catheter dislodgement, occlusion, tip migration, superficial thrombosis, or exit site problems [including leaking and infection]), and device failure, defined as premature device removal due to any device complication. We used multivariable logistic regression to assess the association between obesity and outcomes, adjusting for prespecified covariates.
Results: Of 59,694 patients receiving PICCs during the study period, 3,755 (6.3%) were underweight, 20,438 (34.2%) had normal BMI, 20,407 (34.2%) were overweight, and 15,094 (25.3%) were obese. PICCs placed in patients with obesity had longer dwell time vs patients with normal BMI (median [IQR], 10 days [5-19 days] vs 10 days [5-17 days], p<.001). PICCs in patients with obesity were more likely to be single lumen (56.5% vs 53.7%, p<.001) and less likely to dwell < 5 days (16% vs 17.7%, p<.001), compared to PICCs in patients with normal BMI. Major PICC complications occurred in 2.9% of patients with obesity and 3.4% of patients with normal BMI, p=.01. Device failure occurred in 7.2% of patients with obesity and 7.9% of those with normal BMI, p=.04. After adjusting for covariates, obesity was not associated with major complications (OR 0.92; 95%CI 0.81-1.05) or device failure (OR 0.95; 95%CI 0.87-1.03), but was associated with higher odds of minor complications (OR 1.21; 95%CI 1.13-1.3), particularly catheter occlusion (OR 1.29; 95%CI 1.19-1.41) and exit site problems (OR 1.54; 95%CI 1.15-2.18).
Conclusions: Among hospitalized patients with PICCs, obesity is not associated with major device complications or device failure. However, obesity is associated with greater odds of minor device complications. These findings suggest an opportunity to improve PICC maintenance practices, particularly in patients with obesity.