Assessment of Long-Term Complications in Adult Oncology Patients with Superior Vena Cava Syndrome Receiving Tunnelled Femoral Catheters: A Prospective Cross-sectional Study

Assessment of Long-Term Complications in Adult Oncology Patients with Superior Vena Cava Syndrome Receiving Tunnelled Femoral Catheters: A Prospective Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Long-Term Complications in Adult Oncology Patients with Superior Vena Cava Syndrome Receiving Tunnelled Femoral Catheters: A Prospective Cross-sectional Study Zhen-Ming Wu, Chun-Li Huang, Ze-Yin Hu, Meng-Na Luo, Yu-Ying Fan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5778445/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Superior vena cava syndrome (SVCS) is a critical condition that is often linked to malignancies and requires prolonged vascular access for therapeutic and palliative care. This prospective cohort analysis evaluated the long-term complications associated with tunneled femoral inserted central catheters (TFICCs) in adult oncology patients with SVCSs. Methods This is a prospective cross-sectional study and was performed at a major cancer centre in China. The study involved oncology patients with SVCSs requiring central venous access via the TFICC from March 2022 to June 2022. A total of 89 adult oncology patients with SVCS who received TFICC placement were enrolled. The primary outcomes were the rates of TFICC-related complications, such as dislodgment, occlusion, blood reflux, catheter-related skin injury, catheter-related thrombosis, and unplanned removal. The secondary outcomes included the identification of risk factors associated with these complications. Univariate and binary logistic regression analyses were used to assess risk factors for complications. Results Nearly half of the patients (n = 42/89, 47.2%) experienced significant complications related to TFICC, with dislodgment emerging as the most prevalent issue at an alarming rate of 23.6%. It’s crucial to note that only a mere 5 patients (56%) had their catheters removed due to complications. The use of Power PICC-SOLO catheters was identified as a significant risk factor for occlusion. An increased catheter length reduces the risk of dislodgment, whereas a longer indwelling time increases this risk. A larger thigh circumference was linked to a greater chance of blood reflux. Conclusion TFICC placement in adult oncology patients with SVCSs is associated with a significant rate of complications, particularly concerning dislodgment. POWER PICC-SOLO is associated with a greater risk of occlusion. Catheter length and indwelling time influence the risk of dislodgment, and thigh circumference is a risk factor for blood reflux. These findings have implications for patient selection, catheter choice, and management strategies to minimize complications. Trial registration This study was registered at the Chinese Clinical Trial Registry on 21/02/2022 (registration number: ChiCTR2200055864). Superior vena cava syndrome Tunnelled femoral inserted central catheters Oncology Complications Figures Figure 1 Background Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy( 1 , 2 ). Lung cancer is the most common cause of malignancy and accounts for more than 50% of cases of malignant SVCS( 3 ). Non-Hodgkin’s lymphoma and non-lung cancer metastatic lesions also account for approximately 10% of cases each( 1 ). Chemotherapy is one of the treatment modalities for malignant SVCS, and the inferior vena cava (IVC) is the preferred route for central venous access devices (CVADs) in patients with malignant SVCS( 4 ). This is because that infusion from the superior cava may aggravate the symptoms of SVCS. This clinical challenge necessitates the use of alternative access sites, such as the femoral vein. However, the femoral site of catheter insertion was associated with a higher rate of bloodstream infection and catheter colonization compared to the subclavian and internal jugular( 5 – 8 ). Tunnelled femoral inserted central catheter (TFICC) has been suggested as a feasible and safe alternative venous access for patients with SVCS who require medium to long-term infusion therapy( 9 , 10 ). These catheters are inserted through the femoral vein and tunnelled subcutaneously to an exit site on the abdomen or thigh, providing a route for central venous access while bypassing the obstructed SVCS. A subcutaneous tunnel is generally applied for central venous catheter placement in instances of extended use and is known to significantly reduce infection rates ( 11 ). Despite the potential benefits, there is a paucity of literature on the long-term outcomes of this approach, particularly in the context of adult oncology patients with SVC syndrome. Understanding the long-term outcomes of TFICCs in this patient population is crucial for optimizing patient care, reducing complications, and improving quality of life. Consequently, this study aims to collect the longitudinal data from a cohort of patients, enabling researchers to measure outcomes at multiple time points and assess the incidence of complications, catheter survival, and patient-reported outcomes. Methods Objectives This prospective cross-sectional study aimed to evaluate the long-term outcomes of TFICC placement in adult oncology patients with superior vena cava (SVC) syndrome. The study will involve the enrollment of patients who have been diagnosed with SVC syndrome and are undergoing treatment for malignancies that require long-term vascular access. Participants and enrollment Adult oncology patients with SVCS who required central venous access for chemotherapy, parenteral nutrition, or other treatments and underwent TFICC catheterization between March 2022 and June 2022 were included. The inclusion criteria included age 18 years or older and a confirmed SVCs diagnosis via CT or PET-CT. The exclusion criteria included severe systemic infection, significant inferior extremity/central deep venous thrombosis (DVT), severe coagulopathy, communication barriers, imminent dialysis fistula need, cardiac disease and life expectancy of less than 6 months. This study received approval from the ethics committees at Sun Yat-sen University Cancer Centre (B2021-369-01) and the Chinese Clinical Trial Registry (ChiCTR2200055864, 2022/01/21). Written informed consent was obtained from all participants in this trial. Insertion and maintenance Catheter placement will follow a standardized protocol based on the Rapid Femoral Vein Assessment( 12 ),which was applied to select the optimal venipuncture site in the lower limb. The femoral ZIM was used to determine the optimal exit site ( 13 ). This involves the use of ultrasound guidance for vein puncture, the modified Seldinger technique for catheter insertion, and EKG to verify correct tip placement and prevent kinking in the groin area( 14 ). The supradiaphragmatic inferior vena cava was the optimal catheter tip position, as confirmed by fluoroscopy performed by an interventional radiologist( 15 , 16 ). This study utilized a 4-Fr Groshong® NTX ClearVue™ catheter and a 4-Fr PowerPICC SOLO catheter, both from Bard Access Systems, Inc., UT, USA, featuring three-way valves. Post-insertion care and maintenance were standardized with 3M Tegaderm Diamond Pattern Film Dressing 1679 (3M Health Care, St. Paul, MN, USA), needleless connectors (BD Switzerland Sàrl®; Eysin, Switzerland), and StatLock™ PICC Plus Stabilization Devices (Bard Access Systems, Inc., UT, USA). Follow-up maintenance was performed weekly or as required if the dressing got lifted. Furthermore, 0.9% sodium chloride was used to lock and flush the line. Outcomes The primary outcomes will include the incidence and risk factors for complications related to the TFICC, such as CLABSI, thrombosis, dislodgment, occlusion, premature removal, catheter damage, blood reflux, and catheter-associated skin injury (CASI) including contact dermatitis, exit site infection, weeping/oozing, and skin injury( 17 ). The incidence of PICC-related complications was calculated as the total number of PICC complications divided by the total number of PICCs placed, expressed as a percentage. Complications related to tunnelled FICC were identified and monitored by the vascular access nursing team until the catheter was removed. The definitions of complications are detailed in Supplement File 1. Study design This observational prospective cross-sectional study aimed to explore the prevalence and risk factors for complications related to the TFICC among cancer patients with SVCS. Data collection The hospital information system was used to retrieve patient data, including a range of variables such as demographic and background information, insertion characteristics, and any tunneled FICC complications. Clinical parameters, including body max index (BMI), white blood cell count, red blood cell count, platelet count, haemoglobin concentration, etc., were recorded within the first 24 hours of TFICC placement. All complications related to TFICC, such as thrombosis, infection, occlusion, and dislodgment, were followed until catheter removal. All outcomes were ascertained by medical record review, telephone follow-up, or both after TFICC placement. Statistical analysis Continuous variables are expressed as the means (SDs), and qualitative variables are presented as frequencies (n) and percentages (%). The risk factors for TFICC complications were analysed via univariable analysis and a binary logistic regression model with a forward-selection procedure. Any clinical characteristics with a value of P < 0.1 in the univariable analysis were entered into a binary logistic regression model. These results are presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). All the statistical tests were two-sided, and p values < 0.05 were considered statistically significant. Statistical analysis was performed with SPSS software (Version 26, SPSS Inc., IBM, NY, USA). Results This study involved 89 cancer patients with SVCS, totalling 11,119 catheter days. Patient inclusion is shown in Fig. 1 . Among them, 52 (58.4%) were male and the average age was 43.00 ± 18.07 years. The main indications for TFICC were mediastinal tumours and lymphoma, each accounting for 26 patients (29.2%), followed by lung tumours, accounting for 20 patients (22.5%). There were no differences in the baseline characteristics observed between the groups with and without complications. Additional patient characteristics are detailed in Table 1 . Among all the patients, 42 (47.2%) experienced TFICC-related complications. The most common complication was dislodgment, affecting 21 patients (23.6%), followed by occlusion and blood reflux in 9 patients (10.1%) separately. Additionally, 7 patients (7.9%) had lymphorrhagia, 6 (6.7%) experienced catheter-related thrombosis, and 5 (5.6%) experienced contact dermatitis. Another 5 patients (5.6%) had unplanned removal. Only one patient (1.1%) had a CLABSI. The frequency of TFICC-related complications is detailed in Table 2 . Table 1 Baseline characteristics of cancer patients with TFICC(n = 89) Characteristic Total Patients with TFICC complications(N = 42) Patients without TFICC complications (N = 47) P-value Age(y), mean (SD) 43.00 ± 18.07 39.43 ± 17.95 46.1 ± 17.77 .078 Male, N (%) 52(58.4%) 24(27.0%) 28(31.5%) .833 BMI 23.9 24(27.0%) 9(10.1%) 15(16.9%) KPS score < 60 5(5.6%) 2(2.2%) 3(3.4%) 1.000 WBC counts(10 9 /L), N (%) 9.5 25(28.1%) 9(10.1%) 16(18.0%) RBC counts (10 12 /L), N (%) 5.1 14(15.7%) 10(11.2%) 4(4.5%) Platelets (10 9 /L), N (%) 300 26(29.2%) 13(14.6%) 13(14.6%) Hemoglobin concentration(g/L) 115 70(78.7%) 34(38.2%%) 36(40.4%) Comorbidities, N (%) 16(18.0%) 8(9.0%) 8(9.0%) 1.000 Type of malignancy, N (%) Lung cancer 20(22.5%) 8(9.0%) 12(13.5%) .228 Mediastinal cancer 26(29.2%) 11(12.4%) 15(16.9%) Breast cancer 8(9.0%) 5(5.6%) 3(3.4%) Lymphoma 26(29.2%) 16(18.0%) 10(11.2%) Other cancers 9(10.1%) 2(2.2%) 7(7.9%) Chemotherapy, N (%) 56(62.9%) 23(25.8%) 33(37.1%) .187 Radiotherapy, N (%) 16(18.0%) 9(10.1%) 7(7.9%) .581 Surgery, N (%) 19(21.3%) 7 (7.9%) 12(13.5%) .438 Previous anticoagulants therapeutic, N (%) 11(12.4%) 6(6.7%) 5(5.6%) .750 Previous VTE event, N (%) 11(12.4%) 6(6.7%) 5(5.6%) .750 History of catheterization, N (%) 9(10.1%) 7(7.9%) 2(2.2%) .078 Type of catheter, N (%) Groshong catheter 78(87.6%) 34(38.2%) 44(49.4%) .106 Power PICC solo 11(12.4%) 8(9.0%) 3(3.4%) Right thigh insertion, N (%) 77(86.5%) 38(42.7%) 39(43.8%) .363 Insertion vein, N (%) Superficial Femoral vein 82(92.1%) 39(43.8%) 43(48.3%) 1.000 Great Saphenous Vein 7(7.9%) 3(3.4%) 4(4.5%) Length of catheterization(cm), mean (SD) 50.26 ± 2.49 49.88 ± 2.21 50.60 ± 2.70 .178 Length of tunnel (cm), mean (SD) 7.76 ± 1.63 7.90 ± 1.78 7.64 ± 1.50 .445 Location of tip, N (%) T10 14(15.7%) 7(7.9%) 7(7.9%) .416 T11 26(29.2%) 14(15.7%) 12(13.5%) T12 39(43.8%) 18(20.2%) 21(23.6%) Lower than L1 10(11.2%) 3(3.4%) 7(7.9%) Thigh circumference(cm), mean (SD) 45.51 ± 6.18 46.38 ± 5.71 44.72 + 6.53 .208 Indwelling time (days), mean (SD) 124.93 ± 75.49 128.36 ± 86.48 121.87 + 64.93 .688 TFICC = tunneled femoral inserted central catheter; BMI = body mass index, KPS = Karnofsky Performance Scale; WBC = white blood cell; RBC = Red blood cell; PLT = platelet; HGB = Hemoglobin concentration Table 3 shows the risk factors for different types of TFICC-related complications according to the univariate analysis. In Binary logistic regression analysis, male sex was associated with a 10.4-fold greater risk of occlusion (95%CI = 1.019–107.510, P = .048), as well as the use of Power PICC SOLO catheter, which increased the risk of occlusion 14.6-fold (95%CI = 1.721-124.353, P = .014). The length of catheterization was a protective factor, and a longer insertion catheter reduced the fisk of dislodgment (OR = .685, 95% CI = .531-0.883, P = .004), whereas an increased catheter indwelling time increased the risk (OR = 1.009, 95% CI = 1.001–1.017, P = .029). Patients with larger thigh circumferences had a greater likelihood of blood reflux (OR = 1.168, 95% CI = 1.009–1.352, P = .038). Table 2 The frequency of TFICC complications Type of complications Complications Dislodgment 21(23.6%) Occlusion 9(10.1%) Blood reflux 9(10.1%) CASI Weeping/oozing 8(9.0%) Contact dermatitis 5(5.6%) Exit site infection 1(1.1%) Thrombosis 6(6.7%) Unplanned removal 5(5.6%) Catheter damage 1(1.1%) CLABSI 1(1.1%) Total 66 CLABSI = central line associate bloodstream infection CASI = Catheter-associated skin injury Table 4 presents the binary logistic regression results used to identify factors associated with different TFICC related complications. Male patients are 10.467 times more likely to experience occlusion than female patients (P = .048), although the confidence interval reflects some uncertainty. The power PICC users were 14.630 times more likely to experience occlusion (P = .014). Each additional day of catheter indwelling was associated with a 0.9% increase in the odds of occlusion (P = .029), whereas each additional centimetre of catheter length correlated with a 31.5% reduction in the odds of occlusion (P = .004). In addition, an increase of one centimetre in femoral circumference was associated with a 16.8% increase in the odds of blood reflux (P = .038). Table 3 Univariate analysis among different TFICC complications Characteristics Dislodgment (n = 21) Occlusion (n = 9) Blood reflux (n = 9) Weeping/oozing (n = 7) Unplanned removal(n = 5) Thrombosis (n = 6) Contact dermatitis (n = 5) Age(y) .042 .837 3.068 .083 4.243 .042 1.288 .260 .126 .724 1.211 .274 .436 .511 Gender 2.743 .130 5.403 .031 1.544 .295 .529 .380 .005 1.000 4.578 .039 .005 1.000 BMI .708 .780 1.361 .622 1.387 .557 .893 .741 1.928 .416 1.937 .405 2.534 .266 KPS score .791 .588 .596 1.000 .596 1.000 .452 .657 .315 1.000 .383 1.000 .315 1.000 WBC counts(10E9/L) 5.218 .054 2.660 .280 2.267 .359 3.108 .231 2.728 .282 3.313 .237 2.432 .426 RBC counts(10E12/L) .822 .706 1.329 .578 1.224 .642 8.463 .006 2.458 .293 4.530 .105 .929 .701 Platelet counts (10E9/L) .164 .906 .329 1.000 .397 1.000 .324 1.000 5.905 .043 .805 .727 .457 1.000 Hemoglobin concentration(g/L) .087 1.000 2.718 .195 .625 .677 .236 .638 .006 1.000 1.746 .226 1.438 .580 Comorbidities 2.092 .193 1.601 .201 .122 .662 .070 .632 .015 1.000 .007 .707 1.742 .219 Type of malignancy 4.627 .318 5.592 .180 3.390 .445 2.366 .664 1.448 1.000 1.147 1.000 3.959 .378 Chemotherapy 2.759 .123 .233 .721 3.757 .072 .236 .482 .019 1.000 .460 .393 .019 1.000 Radiotherapy .021 1.000 4.756 .051 .122 .662 .070 .632 1.161 .580 1.029 .293 1.161 .580 Surgery .854 .372 2.718 .195 2.718 .195 .226 .538 1.438 .580 1.746 .226 .006 1.000 Previous Anticoagulants therapeutic .204 1.000 .899 .307 1.412 .594 1.071 .383 .286 .491 .110 .558 .286 .491 Previous VTE event .094 .717 .899 .307 .014 1.000 1.071 .383 .286 .491 .907 1.000 .286 .491 History of catheterization 2.414 .206 .011 1.000 1.126 .590 .855 .461 .596 1.000 .304 .483 .570 .421 Type of catheter 1.135 .280 27.261 < .001 .899 .307 1.071 .383 .747 1.000 .110 .558 .747 1.000 Side of insertion 1.792 .280 .048 1.000 1.560 .603 .004 .651 .826 1.000 .056 .592 .193 .524 Vein of catheter insertion .365 1.000 .146 .539 .146 .539 .649 .552 .452 1.000 .688 .397 .452 1.000 Length of catheterization(cm) 7.521 .007 1.068 .304 .106 .745 .010 .923 .625 .240 .339 .514 .248 .620 Length of tunnel median(cm) .381 .539 1.616 .202 .035 .851 34.262 < .001 1.398 .782 .379 .562 1.870 .175 Location of tip 5.013 .165 1.313 .776 2.727 .417 1.909 .610 6.792 .144 1.274 .762 1.965 .839 Thigh circumference (cm) 1.319 .254 3.732 .057 8.217 .005 .010 .923 .168 .683 .468 .496 .168 .683 Indwelling time(days) 5.945 .017 .399 .529 .234 .630 1.984 .163 6.536 .012 1.029 .313 1.509 .223 Table 4 Binary logistic regression analysis among variables influencing TFICC related complications Complications Characteristics B S.E. Wald OR (95% CI) P-value Occlusion Male 2.348 1.188 3.904 10.467(1.019–107.510) .048 Power PICC solo 2.683 1.092 6.039 14.630(1.721-124.353) .014 Dislodgment Indwelling time(days) .009 .004 4.769 1.009(1.001–1.017) .029 Length of catheterization(cm) − .379 .130 8.515 .685(.531-.883) .004 Blood reflux Thigh circumference(cm) .155 .075 4.300 1.168(1.009–1.352) .038 Discussion The study revealed that nearly half (47.2%) of the patients experienced TFICC-related complications, with dislodgment being the most common issue, affecting 23.6% of the patients. This was followed by occlusion and blood reflux, each occurring in 10.1% of the patients. Lymphorrhagia, catheter-related thrombosis, contact dermatitis, and accidental withdrawal were less common but still significant complications. Notably, only one case of Central Line-Associated Blood Stream Infection (CLABSI) has been reported, indicating a low rate of severe infectious complications. Infection related to the TFICC The current study revealed that the overall incidence of complications was up to 42/89 (47.2%). Despite this, the incidence of CLABSIs (1/89, 1.1%) is found to be much lower than the reported rate in FICC without the tunneling technique( 5 , 18 ). Traditional FICC insertion involving puncturing or cannulating the common femoral vein at the inguinal groove is always unsuggestable because of the increased risk of bloodstream infection( 8 , 19 ). Our study results are consistent with a randomized controlled trial, which revealed that the infection rate at the FICC site in the mid-thigh (1.5%) was significantly lower than that at the groin (21.82%)( 20 ). The implementation of tunneling techniques minimizes the risk of infection by moving the exit site away from the groin, either towards the mid-thigh or upward to the abdomen( 21 ). Consequently, the use of tunneling technology in FICC insertion reduces bloodstream infection risk, broadens its indications, and provides a crucial vascular access solution for cancer with SVCS. Thrombosis related to the TFICC Catheter-related thrombosis in patients with cancer is usually asymptomatic( 22 ). In this study, 6 patients (6.7%) with asymptomatic thrombosis were identified via ultrasound before catheter removal, which is significantly lower than the 14.55%-21.55% incidence of FICC inserted at the groin( 20 , 23 ). The 2024 INS guideline ( 24 ) highlights that localized factors surrounding the VAD may increase the risk of catheter-related thrombosis within the first two weeks of insertion, whereas non-tunneled FICC placed in the femoral vein of the groin, a flexion area leading to micro-movements of the catheter inside the vein, increases the risk of venous thrombosis ( 25 ). Surprisingly, univariate analysis revealed in this study found that male patients are an independent risk factor for asymptomatic thrombosis (X = 4.578, P = .039). This finding is consistent with prior studies, which showed that male sex is associated with an increased risk of PICC related thrombosis( 26 ). According to the previous study, male is more likely to present with proximal deep vein thrombosis in the lower limbs than women( 27 ). However, the cause of the difference in venous thrombosis between the sexes has yet to be identified ( 28 ). Occlusion related to the TFICC Occlusions are problematic because they can cause the loss of central venous access Binary logistic regression analysis confirmed a significant association between male sex and occlusion occurrence, indicating a higher risk. However, the wide 95% confidence interval (1.019–107.510) indicates a degree of uncertainty around this estimate. This could be due to a small sample size or a genuine variability in the data, which means that while the trend is observed, the precise magnitude of the effect may not be as robust as the odds ratio suggests. The Power PICC SOLO has a higher occlusion risk than the Groshong catheter does, as reported by ( 29 ), who noted Groshong's lower complete occlusion rates among haematological patients. The design of the Power PICC SOLO, featuring proximal valve technology and fewer anti-reflux mechanisms, may contribute to blood stagnation and heightened thrombus formation. The link between Power PICC SOLO and occlusion is complex, involving catheter design, management, and patient factors. More research is needed to clarify the mechanisms behind this increased risk. Dislodgment related to the TFICC Accidental FICC dislodgment is common. The dislodgment rate of the TFICC in this study was 23.6%, notably higher than the 10.3% rate for FICCs inserted in the great saphenous ( 30 ). However, none of the dislodgments resulted in accidental withdrawal. In this study, we found that the length of catheterization is a protective factor against dislodgement, whereas a longer dwell time increases the risk. Currently, there is no relevant literature reporting the association between the length of catheterization and dwelling time with dislodgement. The optimal location for the FICC catheter tip is just above the diaphragm at the inferior vena cava/right atrial (IVC/RA) junction ( 24 ). The length of catheterization is affected by the distance between the exit site and the IVC/RA junction. On the other hand, the length of catheterization influences the risk of dislodgement, which highlights the importance of the FICC tip location. ECG, ultrasound, or post-procedure chest radiography is recommended for identifying the tip location ( 24 ). In this study, the median duration of TFICCs was approximately 124.93 ± 75.49 days. Additionally, outpatients with normal activity, which might increase the risk of dislodgement daily, were included in the current study. The high dislodgment risk of FICCs and subcutaneous anchorage are recommended for medium- to long-term femoral access( 31 – 33 ). Thus, tunneling technology can help stabilize the catheter and reduce the risk of dislodgment, but it is not enough to prevent it completely. It should be used along with methods such as tissue glue and anchoring devices( 34 ). Blood reflux related to the TFICC The relationship between an increase in femoral circumference and the risk of blood reflux was found in the current study. An increased femoral circumference may increase vessel depth, altering the angle at which the catheter enters the vessel and causing reflux( 35 ). Vessel size and depth near the catheter, along with femoral anatomy, affect flow during activities. Larger thighs can hinder circulation and increase reflux risk, especially when pressure disrupts blood flow while moving. Thus, femoral circumference might be linked to reflux risk through blood flow patterns. In conclusion, the relationship between femoral circumference and the risk of TFICC blood reflux is multifaceted and complex. Further research is needed to clarify the mechanisms underlying this association and to develop evidence-based practices to mitigate the risk of blood reflux in patients with larger femoral circumferences. This study highlights challenges in using TFICCs for oncology patients with SVC syndrome. The high dislodgment rate emphasizes the need for improved stabilization techniques, even though it doe nott lead to accidental withdrawal. TFICCs, particularly with tunneling, have lower infection and thrombosis rates, although the Power PICC SOLO presents an increased occlusion risk that warrants further research. Groshong catheter valves may limit blood reflux risk, and patient anatomy, particularly femoral circumference, is crucial to consider in catheter management. TFICCs are vital for patients with challenging venous access, but management must align with individual patients to minimize complications. Limitations The study's generalizability is limited by its small sample size and single-centre design, which may introduce biases related to specific clinical practices and demographics. The inclusion and exclusion criteria could further contribute to selection bias, impacting the cohort's representativeness for all oncology patients with SVCS. Future research should focus on larger, multi-centre studies with diverse populations to deepen understanding of TFICC risk. Conclusions This prospective cohort study involving 89 cancer patients with SVCS provides valuable insights into the long-term outcomes of TFICCs. The analysis revealed that 47.2% of patients experienced complications, primarily dislodgment. These findings underscore the need to consider patient-specific factors and catheter types during TFICC placement. The increased risk of occlusion with Power PICC SOLO catheters suggests that the need to explore other type of catheter. Longer catheter lengths may reduce dislodgment, whereas thigh circumference is related to blood reflux, emphasizing careful patient selection and exit site management. Clinicians should closely monitor identified risk factors. Further research is necessary to confirm these findings and improve strategies to minimize TFICC-related complications. In summary, this study enhances the understanding of TFICC complications in oncology patients with SVCS and calls for tailored management approaches. Declarations Ethics approval and consent to participate This study received approval from the Chinese Clinical Trial Registry (ChiCTR2200055864, 2022/01/21). Declaration of conflicts of interest All authors declare no conflict of interest. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Funding sources No external funding. Authors' contributions Zhen-Ming Wu and Chun-Li Huang contributed equally to this manuscript, overseeing the study's conception, design, data acquisition, analysis, interpretation, and article drafting. Ze-Yin Hu, Meng-Na Luo, and Yu-Ying Fan were responsible for data acquisition. Jia Li provided final approval for the submitted version. Acknowledgements No. References Wright K, Digby GC, Gyawali B, Jad R, Menard A, Moraes FY, et al. Malignant Superior Vena Cava Syndrome: A Scoping Review. J Thorac Oncol. 2023;18(10):1268–76. Patriarcheas V, Grammoustianou M, Ptohis N, Thanou I, Kostis M, Gkiozos I, et al. Malignant Superior Vena Cava Syndrome: State Art Cureus. 2022;14(1):e20924. Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356(18):1862–9. Rowell NP, Gleeson FV. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus. Cochrane Database Syst Rev. 2001(4):Cd001316. Pitiriga V, Kanellopoulos P, Bakalis I, Kampos E, Sagris I, Saroglou G, et al. Central venous catheter-related bloodstream infection and colonization: the impact of insertion site and distribution of multidrug-resistant pathogens. Antimicrob Resist Infect Control. 2020;9(1):189. Iachkine J, Buetti N, de Grooth HJ, Briant AR, Mimoz O, Mégarbane B, et al. Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials. Crit Care. 2022;26(1):205. Parienti JJ, Mongardon N, Mégarbane B, Mira JP, Kalfon P, Gros A, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med. 2015;373(13):1220–9. Arvaniti K, Lathyris D, Blot S, Apostolidou-Kiouti F, Koulenti D, Haidich AB. Cumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients: A Pairwise and Network Meta-Analysis. Crit Care Med. 2017;45(4):e437–48. Wan Y, Chu Y, Qiu Y, Chen Q, Zhou W, Song Q. The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome. J Vasc Access. 2018;19(1):34–9. Zhao L, Cao X, Wang Y. Cannulation of the superficial femoral vein at mid-thigh when catheterization of the superior vena cava system is contraindicated. J Vasc Access. 2020;21(4):524–8. Nahum E, Levy I, Katz J, Samra Z, Ashkenazi S, Ben-Ari J, et al. Efficacy of subcutaneous tunneling for prevention of bacterial colonization of femoral central venous catheters in critically ill children. Pediatr Infect Dis J. 2002;21(11):1000–4. Brescia F, Pittiruti M, Ostroff M, Biasucci DG. Rapid Femoral Vein Assessment (RaFeVA): A systematic protocol for ultrasound evaluation of the veins of the lower limb, so to optimize the insertion of femorally inserted central catheters. J Vasc Access. 2021;22(6):863–72. Brescia F, Pittiruti M, Ostroff M, Spencer TR, Dawson RB. The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters. J Vasc Access. 2021:11297298211041442. Weber MD, Himebauch AS, Conlon T. Use of intracavitary-ECG for tip location of femorally inserted central catheters. J Vasc Access. 2022;23(1):166–70. Annetta MG, Marche B, Giarretta I, Pittiruti M. Applicability and feasibility of intraprocedural tip location of femorally inserted central catheters by transhepatic ultrasound visualization of the inferior vena cava in adult patients. J Vasc Access. 2023:11297298231153979. Gupta N, Gandhi D, Sharma S, Goyal P, Choudhary G, Li S. Tunneled and routine peripherally inserted central catheters placement in adult and pediatric population: review, technical feasibility, and troubleshooting. Quant Imaging Med Surg. 2021;11(4):1619–27. Broadhurst D, Moureau N, Ullman AJ. Management of Central Venous Access Device-Associated Skin Impairment: An Evidence-Based Algorithm. J Wound Ostomy Cont Nurs. 2017;44(3):211–20. Parienti J-J, Mongardon N, Mégarbane B, Mira J-P, Kalfon P, Gros A, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med. 2015;373(13):1220–9. Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40(8):2479–85. Zhang J, Tang S, Hu C, Zhang C, He L, Li X, et al. Femorally inserted central venous catheter in patients with superior vena cava obstruction: choice of the optimal exit site. J Vasc Access. 2017;18(1):82–8. Annetta MG, Elli S, Marche B, Pinelli F, Pittiruti M. Femoral venous access: State of the art and future perspectives. J Vasc Access. 2023:11297298231209253. Illig KA, Gober L. Optimal management of upper extremity deep vein thrombosis: Is venous thoracic outlet syndrome underrecognized? J Vasc Surg Venous Lymphat Disord. 2022;10(2):514–26. Ge X, Cavallazzi R, Li C, Pan SM, Wang YW, Wang FL. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev. 2012;2012(3):Cd004084. Nickel B, Gorski L, Kleidon T, Kyes A, DeVries M, Keogh S et al. Infusion Therapy Standards of Practice, 9th Edition. J Infus Nurs. 2024;47(1S Suppl 1):S1-s285. Hou J, Zhang J, Ma M, Gong Z, Xu B, Shi Z. Thrombotic risk factors in patients with superior vena cava syndrome undergoing chemotherapy via femoral inserted central catheter. Thromb Res. 2019;184:38–43. Wang P, He L, Yuan Q, Lu J, Ji Q, Peng A, et al. Risk factors for peripherally inserted central catheter-related venous thrombosis in adult patients with cancer. Thromb J. 2024;22(1):6. Barco S, Klok FA, Mahé I, Marchena PJ, Ballaz A, Rubio CM, et al. Impact of sex, age, and risk factors for venous thromboembolism on the initial presentation of first isolated symptomatic acute deep vein thrombosis. Thromb Res. 2019;173:166–71. Roach REJ, Lijfering WM, Rosendaal FR, Cannegieter SC, le Cessie S. Sex Difference in Risk of Second but Not of First Venous Thrombosis. Circulation. 2014;129(1):51–6. Scrivens N, Sabri E, Bredeson C, McDiarmid S. Comparison of complication rates and incidences associated with different peripherally inserted central catheters (PICC) in patients with hematological malignancies: a retrospective cohort study. Leuk Lymphoma. 2020;61(1):156–64. Jin MF, Thompson SM, Comstock AC, Levy ER, Reisenauer CJ, McPhail IR, et al. Technical success and safety of peripherally inserted central catheters in the great saphenous and anterior accessory great saphenous veins. J Vasc Access. 2022;23(2):280–5. Brescia F, Pittiruti M, Roveredo L, Zanier C, Morabito A, Santarossa E, et al. Subcutaneously anchored securement for peripherally inserted central catheters: Immediate, early, and late complications. J Vasc Access. 2023;24(1):82–6. Hawes ML, McCormick CA, Gilbert GE. A retrospective study of subcutaneous anchor securement systems in oncology patients. J Vasc Access. 2023:11297298231190416. Crocoli A, Martucci C, Sidro L, Delle Donne D, Menna G, Pittiruti M, et al. Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study. J Vasc Access. 2023;24(1):35–40. Giustivi D, Donadoni M, Elli SM, Casella F, Quici M, Cogliati C, et al. Brachial Tunneled Peripherally Inserted Central Catheters and the Risk of Catheter Complications: A Systematic Review and Meta-Analysis. Nurs Rep. 2024;14(1):455–67. Zambetti BR, Kankaria A, Fang F, Kim N, Nagarsheth K, Sarkar R. Diameter and depth of femoral vessels by duplex ultrasound. J Vasc Access. 2023:11297298231200036. Additional Declarations No competing interests reported. Supplementary Files SupplementFile1..docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 May, 2025 Reviews received at journal 01 Mar, 2025 Reviews received at journal 23 Feb, 2025 Reviews received at journal 23 Feb, 2025 Reviewers agreed at journal 23 Feb, 2025 Reviewers agreed at journal 19 Feb, 2025 Reviewers agreed at journal 18 Feb, 2025 Reviews received at journal 17 Feb, 2025 Reviewers agreed at journal 17 Feb, 2025 Reviewers agreed at journal 16 Feb, 2025 Reviewers invited by journal 16 Feb, 2025 Editor invited by journal 16 Jan, 2025 Editor assigned by journal 16 Jan, 2025 Submission checks completed at journal 09 Jan, 2025 First submitted to journal 07 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5778445","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":399935869,"identity":"b88e6354-24e3-43cf-ba42-1b2bde8daf82","order_by":0,"name":"Zhen-Ming Wu","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Zhen-Ming","middleName":"","lastName":"Wu","suffix":""},{"id":399935870,"identity":"10fc12e9-8588-4eba-8b33-9a78e6becdf7","order_by":1,"name":"Chun-Li Huang","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Chun-Li","middleName":"","lastName":"Huang","suffix":""},{"id":399935871,"identity":"1cf266cb-9d65-4b4e-a4ec-8419fdcacffa","order_by":2,"name":"Ze-Yin Hu","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Ze-Yin","middleName":"","lastName":"Hu","suffix":""},{"id":399935872,"identity":"231ba113-261f-482d-aa1a-022725471d05","order_by":3,"name":"Meng-Na Luo","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Meng-Na","middleName":"","lastName":"Luo","suffix":""},{"id":399935873,"identity":"9fb3f8f5-4aa5-4e05-9074-657b4e58ce8e","order_by":4,"name":"Yu-Ying Fan","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Yu-Ying","middleName":"","lastName":"Fan","suffix":""},{"id":399935874,"identity":"c151aea3-6e88-467b-8e93-5f88156ae4d9","order_by":5,"name":"Jia Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBAC9mYGxgMJBjYkaGFsZmA4kFCQRoqWBqAWhg+HSdHSzvzgwAOD8/YG588YfvjBYJMv78D87AF+h7EZAP1yO3HDjRxjyR6GNMuNB9jMDfBrYQBrSTC4wWPGzMBw2MCwgYdNAr8W9g9ALedADiNSi2AzD8iWA4wbDuRAtMgzENAizcxTANSSnDjzRlqxZI9BmoEBM5sZXi18/Mc3Pvzxx86e7/zhjR9+VNgYyLc3P8OrBQ4UDoBIYFAZEB1H8g3ojFEwCkbBKBgFUAAAZKxFoc/k6coAAAAASUVORK5CYII=","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":true,"prefix":"","firstName":"Jia","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-01-07 06:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5778445/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5778445/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73870410,"identity":"81513fe5-6d58-4a9e-ac21-c30aec3cdc00","added_by":"auto","created_at":"2025-01-15 12:18:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":268275,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of included patients.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5778445/v1/cb0c27fc6832909af2071950.png"},{"id":73872000,"identity":"b02cf5e4-fb16-430f-a7e2-eddffdfa25b4","added_by":"auto","created_at":"2025-01-15 12:26:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1237860,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5778445/v1/f8f60069-b084-4d10-8544-d88b0375db7a.pdf"},{"id":73867877,"identity":"9bdd8ef6-31d3-4867-b6e2-25217f0b0bb5","added_by":"auto","created_at":"2025-01-15 12:02:29","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15029,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementFile1..docx","url":"https://assets-eu.researchsquare.com/files/rs-5778445/v1/0e3131b32d865eb40635c536.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Long-Term Complications in Adult Oncology Patients with Superior Vena Cava Syndrome Receiving Tunnelled Femoral Catheters: A Prospective Cross-sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eMalignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Lung cancer is the most common cause of malignancy and accounts for more than 50% of cases of malignant SVCS(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Non-Hodgkin\u0026rsquo;s lymphoma and non-lung cancer metastatic lesions also account for approximately 10% of cases each(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChemotherapy is one of the treatment modalities for malignant SVCS, and the inferior vena cava (IVC) is the preferred route for central venous access devices (CVADs) in patients with malignant SVCS(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This is because that infusion from the superior cava may aggravate the symptoms of SVCS. This clinical challenge necessitates the use of alternative access sites, such as the femoral vein. However, the femoral site of catheter insertion was associated with a higher rate of bloodstream infection and catheter colonization compared to the subclavian and internal jugular(\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTunnelled femoral inserted central catheter (TFICC) has been suggested as a feasible and safe alternative venous access for patients with SVCS who require medium to long-term infusion therapy(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These catheters are inserted through the femoral vein and tunnelled subcutaneously to an exit site on the abdomen or thigh, providing a route for central venous access while bypassing the obstructed SVCS. A subcutaneous tunnel is generally applied for central venous catheter placement in instances of extended use and is known to significantly reduce infection rates (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the potential benefits, there is a paucity of literature on the long-term outcomes of this approach, particularly in the context of adult oncology patients with SVC syndrome. Understanding the long-term outcomes of TFICCs in this patient population is crucial for optimizing patient care, reducing complications, and improving quality of life. Consequently, this study aims to collect the longitudinal data from a cohort of patients, enabling researchers to measure outcomes at multiple time points and assess the incidence of complications, catheter survival, and patient-reported outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis prospective cross-sectional study aimed to evaluate the long-term outcomes of TFICC placement in adult oncology patients with superior vena cava (SVC) syndrome. The study will involve the enrollment of patients who have been diagnosed with SVC syndrome and are undergoing treatment for malignancies that require long-term vascular access.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and enrollment\u003c/h3\u003e\n\u003cp\u003eAdult oncology patients with SVCS who required central venous access for chemotherapy, parenteral nutrition, or other treatments and underwent TFICC catheterization between March 2022 and June 2022 were included. The inclusion criteria included age 18 years or older and a confirmed SVCs diagnosis via CT or PET-CT. The exclusion criteria included severe systemic infection, significant inferior extremity/central deep venous thrombosis (DVT), severe coagulopathy, communication barriers, imminent dialysis fistula need, cardiac disease and life expectancy of less than 6 months. This study received approval from the ethics committees at Sun Yat-sen University Cancer Centre (B2021-369-01) and the Chinese Clinical Trial Registry (ChiCTR2200055864, 2022/01/21). Written informed consent was obtained from all participants in this trial.\u003c/p\u003e\n\u003ch3\u003eInsertion and maintenance\u003c/h3\u003e\n\u003cp\u003eCatheter placement will follow a standardized protocol based on the Rapid Femoral Vein Assessment(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e),which was applied to select the optimal venipuncture site in the lower limb. The femoral ZIM was used to determine the optimal exit site (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This involves the use of ultrasound guidance for vein puncture, the modified Seldinger technique for catheter insertion, and EKG to verify correct tip placement and prevent kinking in the groin area(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The supradiaphragmatic inferior vena cava was the optimal catheter tip position, as confirmed by fluoroscopy performed by an interventional radiologist(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This study utilized a 4-Fr Groshong\u0026reg; NTX ClearVue\u0026trade; catheter and a 4-Fr PowerPICC SOLO catheter, both from Bard Access Systems, Inc., UT, USA, featuring three-way valves.\u003c/p\u003e \u003cp\u003ePost-insertion care and maintenance were standardized with 3M Tegaderm Diamond Pattern Film Dressing 1679 (3M Health Care, St. Paul, MN, USA), needleless connectors (BD Switzerland S\u0026agrave;rl\u0026reg;; Eysin, Switzerland), and StatLock\u0026trade; PICC Plus Stabilization Devices (Bard Access Systems, Inc., UT, USA). Follow-up maintenance was performed weekly or as required if the dressing got lifted. Furthermore, 0.9% sodium chloride was used to lock and flush the line.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcomes will include the incidence and risk factors for complications related to the TFICC, such as CLABSI, thrombosis, dislodgment, occlusion, premature removal, catheter damage, blood reflux, and catheter-associated skin injury (CASI) including contact dermatitis, exit site infection, weeping/oozing, and skin injury(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The incidence of PICC-related complications was calculated as the total number of PICC complications divided by the total number of PICCs placed, expressed as a percentage. Complications related to tunnelled FICC were identified and monitored by the vascular access nursing team until the catheter was removed. The definitions of complications are detailed in Supplement File 1.\u003c/p\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eThis observational prospective cross-sectional study aimed to explore the prevalence and risk factors for complications related to the TFICC among cancer patients with SVCS.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe hospital information system was used to retrieve patient data, including a range of variables such as demographic and background information, insertion characteristics, and any tunneled FICC complications. Clinical parameters, including body max index (BMI), white blood cell count, red blood cell count, platelet count, haemoglobin concentration, etc., were recorded within the first 24 hours of TFICC placement. All complications related to TFICC, such as thrombosis, infection, occlusion, and dislodgment, were followed until catheter removal. All outcomes were ascertained by medical record review, telephone follow-up, or both after TFICC placement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are expressed as the means (SDs), and qualitative variables are presented as frequencies (n) and percentages (%). The risk factors for TFICC complications were analysed via univariable analysis and a binary logistic regression model with a forward-selection procedure. Any clinical characteristics with a value of P\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the univariable analysis were entered into a binary logistic regression model. These results are presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). All the statistical tests were two-sided, and p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant. Statistical analysis was performed with SPSS software (Version 26, SPSS Inc., IBM, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study involved 89 cancer patients with SVCS, totalling 11,119 catheter days. Patient inclusion is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among them, 52 (58.4%) were male and the average age was 43.00\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;18.07 years. The main indications for TFICC were mediastinal tumours and lymphoma, each accounting for 26 patients (29.2%), followed by lung tumours, accounting for 20 patients (22.5%). There were no differences in the baseline characteristics observed between the groups with and without complications. Additional patient characteristics are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAmong all the patients, 42 (47.2%) experienced TFICC-related complications. The most common complication was dislodgment, affecting 21 patients (23.6%), followed by occlusion and blood reflux in 9 patients (10.1%) separately. Additionally, 7 patients (7.9%) had lymphorrhagia, 6 (6.7%) experienced catheter-related thrombosis, and 5 (5.6%) experienced contact dermatitis. Another 5 patients (5.6%) had unplanned removal. Only one patient (1.1%) had a CLABSI. The frequency of TFICC-related complications is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of cancer patients with TFICC(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePatients with TFICC complications(N\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003ePatients without TFICC complications (N\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eAge(y), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e43.00\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;18.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e39.43\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;17.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e46.1\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;17.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eMale, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e52(58.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24(27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e28(31.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.833\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13(14.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6(6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e18.5\u0026ndash;23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e52(58.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e27(30.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25(28.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e24(27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9(10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e15(16.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eKPS score\u0026thinsp;\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5(5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2(2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3(3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eWBC counts(10\u003csup\u003e9\u003c/sup\u003e/L), N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3(3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3(3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e3.5\u0026ndash;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e61(68.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e30(33.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e31(34.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25(28.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9(10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e16(18.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eRBC counts (10\u003csup\u003e12\u003c/sup\u003e/L), N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e33(37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e17(19.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e3.8\u0026ndash;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e42(47.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e26(29.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14(15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10(11.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4(4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePlatelets (10\u003csup\u003e9\u003c/sup\u003e/L), N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3(3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1(1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2(2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.927\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e100\u0026ndash;300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e60(67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e28(31.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e32(36.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26(29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13(14.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13(14.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eHemoglobin concentration(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19(21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8(9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11(12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.796\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e70(78.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e34(38.2%%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e36(40.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eComorbidities, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8(9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8(9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eType of malignancy, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20(22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8(9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12(13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eMediastinal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26(29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11(12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e15(16.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eBreast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8(9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5(5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3(3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26(29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10(11.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eOther cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9(10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2(2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7(7.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eChemotherapy, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e56(62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23(25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e33(37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eRadiotherapy, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9(10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eSurgery, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19(21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12(13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003ePrevious anticoagulants therapeutic, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11(12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6(6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5(5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.750\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003ePrevious VTE event, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11(12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6(6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5(5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.750\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eHistory of catheterization, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9(10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2(2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eType of catheter, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eGroshong catheter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e78(87.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e34(38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44(49.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003ePower PICC solo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11(12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8(9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3(3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eRight thigh insertion, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e77(86.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e38(42.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e39(43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eInsertion vein, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e \u003cp\u003eSuperficial Femoral vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e82(92.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e39(43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e43(48.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eGreat Saphenous Vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3(3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4(4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eLength of catheterization(cm), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e50.26\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e49.88\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e50.60\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eLength of tunnel (cm), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.76\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7.90\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7.64\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.445\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eLocation of tip, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eT10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14(15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eT11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26(29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14(15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12(13.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eT12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e39(43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18(20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e21(23.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eLower than L1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10(11.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3(3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7(7.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eThigh circumference(cm), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45.51\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;6.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e46.38\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44.72\u0026thinsp;+\u0026thinsp;6.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eIndwelling time (days), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e124.93\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;75.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e128.36\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;86.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e121.87\u0026thinsp;+\u0026thinsp;64.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.688\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003eTFICC\u0026thinsp;=\u0026thinsp;tunneled femoral inserted central catheter; BMI\u0026thinsp;=\u0026thinsp;body mass index, KPS\u0026thinsp;=\u0026thinsp;Karnofsky Performance Scale; WBC\u0026thinsp;=\u0026thinsp;white blood cell; RBC\u0026thinsp;=\u0026thinsp;Red blood cell; PLT\u0026thinsp;=\u0026thinsp;platelet; HGB\u0026thinsp;=\u0026thinsp;Hemoglobin concentration\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the risk factors for different types of TFICC-related complications according to the univariate analysis. In Binary logistic regression analysis, male sex was associated with a 10.4-fold greater risk of occlusion (95%CI\u0026thinsp;=\u0026thinsp;1.019\u0026ndash;107.510, P\u0026thinsp;=\u0026thinsp;.048), as well as the use of Power PICC SOLO catheter, which increased the risk of occlusion 14.6-fold (95%CI\u0026thinsp;=\u0026thinsp;1.721-124.353, P\u0026thinsp;=\u0026thinsp;.014). The length of catheterization was a protective factor, and a longer insertion catheter reduced the fisk of dislodgment (OR\u0026thinsp;=\u0026thinsp;.685, 95% CI\u0026thinsp;=\u0026thinsp;.531-0.883, P\u0026thinsp;=\u0026thinsp;.004), whereas an increased catheter indwelling time increased the risk (OR\u0026thinsp;=\u0026thinsp;1.009, 95% CI\u0026thinsp;=\u0026thinsp;1.001\u0026ndash;1.017, P\u0026thinsp;=\u0026thinsp;.029). Patients with larger thigh circumferences had a greater likelihood of blood reflux (OR\u0026thinsp;=\u0026thinsp;1.168, 95% CI\u0026thinsp;=\u0026thinsp;1.009\u0026ndash;1.352, P\u0026thinsp;=\u0026thinsp;.038).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe frequency of TFICC complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eType of complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDislodgment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(23.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOcclusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(10.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBlood reflux\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(10.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCASI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeeping/oozing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(9.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContact dermatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(5.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExit site infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eUnplanned removal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(5.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCatheter damage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCLABSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eCLABSI\u0026thinsp;=\u0026thinsp;central line associate bloodstream infection\u003c/p\u003e \u003cp\u003eCASI\u0026thinsp;=\u0026thinsp;Catheter-associated skin injury\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the binary logistic regression results used to identify factors associated with different TFICC related complications. Male patients are 10.467 times more likely to experience occlusion than female patients (P\u0026thinsp;=\u0026thinsp;.048), although the confidence interval reflects some uncertainty. The power PICC users were 14.630 times more likely to experience occlusion (P\u0026thinsp;=\u0026thinsp;.014). Each additional day of catheter indwelling was associated with a 0.9% increase in the odds of occlusion (P\u0026thinsp;=\u0026thinsp;.029), whereas each additional centimetre of catheter length correlated with a 31.5% reduction in the odds of occlusion (P\u0026thinsp;=\u0026thinsp;.004). In addition, an increase of one centimetre in femoral circumference was associated with a 16.8% increase in the odds of blood reflux (P\u0026thinsp;=\u0026thinsp;.038).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis among different TFICC complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"15\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDislodgment\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eOcclusion\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eBlood reflux\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eWeeping/oozing\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eUnplanned removal(n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eThrombosis (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003eContact dermatitis (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.837\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKPS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC counts(10E9/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.426\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRBC counts(10E12/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet counts (10E9/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin concentration(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of malignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3.959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.378\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.756\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious Anticoagulants therapeutic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious VTE event\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of catheterization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.421\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of catheter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide of insertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.524\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVein of catheter insertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of catheterization(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of tunnel median(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1.870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of tip\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.839\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThigh circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndwelling time(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary logistic regression analysis among variables influencing TFICC related complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOcclusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.467(1.019\u0026ndash;107.510)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePower PICC solo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.630(1.721-124.353)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDislodgment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndwelling time(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.009(1.001\u0026ndash;1.017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLength of catheterization(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.685(.531-.883)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood reflux\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThigh circumference(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.168(1.009\u0026ndash;1.352)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study revealed that nearly half (47.2%) of the patients experienced TFICC-related complications, with dislodgment being the most common issue, affecting 23.6% of the patients. This was followed by occlusion and blood reflux, each occurring in 10.1% of the patients. Lymphorrhagia, catheter-related thrombosis, contact dermatitis, and accidental withdrawal were less common but still significant complications. Notably, only one case of Central Line-Associated Blood Stream Infection (CLABSI) has been reported, indicating a low rate of severe infectious complications.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eInfection related to the TFICC\u003c/h2\u003e \u003cp\u003eThe current study revealed that the overall incidence of complications was up to 42/89 (47.2%). Despite this, the incidence of CLABSIs (1/89, 1.1%) is found to be much lower than the reported rate in FICC without the tunneling technique(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Traditional FICC insertion involving puncturing or cannulating the common femoral vein at the inguinal groove is always unsuggestable because of the increased risk of bloodstream infection(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Our study results are consistent with a randomized controlled trial, which revealed that the infection rate at the FICC site in the mid-thigh (1.5%) was significantly lower than that at the groin (21.82%)(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The implementation of tunneling techniques minimizes the risk of infection by moving the exit site away from the groin, either towards the mid-thigh or upward to the abdomen(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Consequently, the use of tunneling technology in FICC insertion reduces bloodstream infection risk, broadens its indications, and provides a crucial vascular access solution for cancer with SVCS.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThrombosis related to the TFICC\u003c/h2\u003e \u003cp\u003eCatheter-related thrombosis in patients with cancer is usually asymptomatic(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In this study, 6 patients (6.7%) with asymptomatic thrombosis were identified via ultrasound before catheter removal, which is significantly lower than the 14.55%-21.55% incidence of FICC inserted at the groin(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The 2024 INS guideline (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) highlights that localized factors surrounding the VAD may increase the risk of catheter-related thrombosis within the first two weeks of insertion, whereas non-tunneled FICC placed in the femoral vein of the groin, a flexion area leading to micro-movements of the catheter inside the vein, increases the risk of venous thrombosis (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Surprisingly, univariate analysis revealed in this study found that male patients are an independent risk factor for asymptomatic thrombosis (X\u0026thinsp;=\u0026thinsp;4.578, P\u0026thinsp;=\u0026thinsp;.039). This finding is consistent with prior studies, which showed that male sex is associated with an increased risk of PICC related thrombosis(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). According to the previous study, male is more likely to present with proximal deep vein thrombosis in the lower limbs than women(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, the cause of the difference in venous thrombosis between the sexes has yet to be identified (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eOcclusion related to the TFICC\u003c/h2\u003e \u003cp\u003eOcclusions are problematic because they can cause the loss of central venous access Binary logistic regression analysis confirmed a significant association between male sex and occlusion occurrence, indicating a higher risk. However, the wide 95% confidence interval (1.019\u0026ndash;107.510) indicates a degree of uncertainty around this estimate. This could be due to a small sample size or a genuine variability in the data, which means that while the trend is observed, the precise magnitude of the effect may not be as robust as the odds ratio suggests.\u003c/p\u003e \u003cp\u003eThe Power PICC SOLO has a higher occlusion risk than the Groshong catheter does, as reported by (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), who noted Groshong's lower complete occlusion rates among haematological patients. The design of the Power PICC SOLO, featuring proximal valve technology and fewer anti-reflux mechanisms, may contribute to blood stagnation and heightened thrombus formation. The link between Power PICC SOLO and occlusion is complex, involving catheter design, management, and patient factors. More research is needed to clarify the mechanisms behind this increased risk.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDislodgment related to the TFICC\u003c/h2\u003e \u003cp\u003eAccidental FICC dislodgment is common. The dislodgment rate of the TFICC in this study was 23.6%, notably higher than the 10.3% rate for FICCs inserted in the great saphenous (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, none of the dislodgments resulted in accidental withdrawal. In this study, we found that the length of catheterization is a protective factor against dislodgement, whereas a longer dwell time increases the risk. Currently, there is no relevant literature reporting the association between the length of catheterization and dwelling time with dislodgement. The optimal location for the FICC catheter tip is just above the diaphragm at the inferior vena cava/right atrial (IVC/RA) junction (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The length of catheterization is affected by the distance between the exit site and the IVC/RA junction. On the other hand, the length of catheterization influences the risk of dislodgement, which highlights the importance of the FICC tip location. ECG, ultrasound, or post-procedure chest radiography is recommended for identifying the tip location (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the median duration of TFICCs was approximately 124.93\u0026thinsp;\u0026plusmn;\u0026thinsp;75.49 days. Additionally, outpatients with normal activity, which might increase the risk of dislodgement daily, were included in the current study. The high dislodgment risk of FICCs and subcutaneous anchorage are recommended for medium- to long-term femoral access(\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Thus, tunneling technology can help stabilize the catheter and reduce the risk of dislodgment, but it is not enough to prevent it completely. It should be used along with methods such as tissue glue and anchoring devices(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eBlood reflux related to the TFICC\u003c/h2\u003e \u003cp\u003eThe relationship between an increase in femoral circumference and the risk of blood reflux was found in the current study. An increased femoral circumference may increase vessel depth, altering the angle at which the catheter enters the vessel and causing reflux(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Vessel size and depth near the catheter, along with femoral anatomy, affect flow during activities. Larger thighs can hinder circulation and increase reflux risk, especially when pressure disrupts blood flow while moving. Thus, femoral circumference might be linked to reflux risk through blood flow patterns. In conclusion, the relationship between femoral circumference and the risk of TFICC blood reflux is multifaceted and complex. Further research is needed to clarify the mechanisms underlying this association and to develop evidence-based practices to mitigate the risk of blood reflux in patients with larger femoral circumferences.\u003c/p\u003e \u003cp\u003eThis study highlights challenges in using TFICCs for oncology patients with SVC syndrome. The high dislodgment rate emphasizes the need for improved stabilization techniques, even though it doe nott lead to accidental withdrawal. TFICCs, particularly with tunneling, have lower infection and thrombosis rates, although the Power PICC SOLO presents an increased occlusion risk that warrants further research. Groshong catheter valves may limit blood reflux risk, and patient anatomy, particularly femoral circumference, is crucial to consider in catheter management. TFICCs are vital for patients with challenging venous access, but management must align with individual patients to minimize complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe study's generalizability is limited by its small sample size and single-centre design, which may introduce biases related to specific clinical practices and demographics. The inclusion and exclusion criteria could further contribute to selection bias, impacting the cohort's representativeness for all oncology patients with SVCS. Future research should focus on larger, multi-centre studies with diverse populations to deepen understanding of TFICC risk.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis prospective cohort study involving 89 cancer patients with SVCS provides valuable insights into the long-term outcomes of TFICCs. The analysis revealed that 47.2% of patients experienced complications, primarily dislodgment. These findings underscore the need to consider patient-specific factors and catheter types during TFICC placement. The increased risk of occlusion with Power PICC SOLO catheters suggests that the need to explore other type of catheter. Longer catheter lengths may reduce dislodgment, whereas thigh circumference is related to blood reflux, emphasizing careful patient selection and exit site management. Clinicians should closely monitor identified risk factors. Further research is necessary to confirm these findings and improve strategies to minimize TFICC-related complications. In summary, this study enhances the understanding of TFICC complications in oncology patients with SVCS and calls for tailored management approaches.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received approval from the Chinese Clinical Trial Registry (ChiCTR2200055864, 2022/01/21).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhen-Ming Wu and Chun-Li Huang contributed equally to this manuscript, overseeing the study\u0026apos;s conception, design, data acquisition, analysis, interpretation, and article drafting. Ze-Yin Hu, Meng-Na Luo, and Yu-Ying Fan were responsible for data acquisition. Jia Li provided final approval for the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWright K, Digby GC, Gyawali B, Jad R, Menard A, Moraes FY, et al. Malignant Superior Vena Cava Syndrome: A Scoping Review. J Thorac Oncol. 2023;18(10):1268\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatriarcheas V, Grammoustianou M, Ptohis N, Thanou I, Kostis M, Gkiozos I, et al. Malignant Superior Vena Cava Syndrome: State Art Cureus. 2022;14(1):e20924.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356(18):1862\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRowell NP, Gleeson FV. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus. Cochrane Database Syst Rev. 2001(4):Cd001316.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitiriga V, Kanellopoulos P, Bakalis I, Kampos E, Sagris I, Saroglou G, et al. Central venous catheter-related bloodstream infection and colonization: the impact of insertion site and distribution of multidrug-resistant pathogens. Antimicrob Resist Infect Control. 2020;9(1):189.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIachkine J, Buetti N, de Grooth HJ, Briant AR, Mimoz O, M\u0026eacute;garbane B, et al. Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials. Crit Care. 2022;26(1):205.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParienti JJ, Mongardon N, M\u0026eacute;garbane B, Mira JP, Kalfon P, Gros A, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med. 2015;373(13):1220\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArvaniti K, Lathyris D, Blot S, Apostolidou-Kiouti F, Koulenti D, Haidich AB. Cumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients: A Pairwise and Network Meta-Analysis. Crit Care Med. 2017;45(4):e437\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWan Y, Chu Y, Qiu Y, Chen Q, Zhou W, Song Q. The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome. J Vasc Access. 2018;19(1):34\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao L, Cao X, Wang Y. Cannulation of the superficial femoral vein at mid-thigh when catheterization of the superior vena cava system is contraindicated. J Vasc Access. 2020;21(4):524\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNahum E, Levy I, Katz J, Samra Z, Ashkenazi S, Ben-Ari J, et al. Efficacy of subcutaneous tunneling for prevention of bacterial colonization of femoral central venous catheters in critically ill children. Pediatr Infect Dis J. 2002;21(11):1000\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrescia F, Pittiruti M, Ostroff M, Biasucci DG. Rapid Femoral Vein Assessment (RaFeVA): A systematic protocol for ultrasound evaluation of the veins of the lower limb, so to optimize the insertion of femorally inserted central catheters. J Vasc Access. 2021;22(6):863\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrescia F, Pittiruti M, Ostroff M, Spencer TR, Dawson RB. The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters. J Vasc Access. 2021:11297298211041442.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeber MD, Himebauch AS, Conlon T. Use of intracavitary-ECG for tip location of femorally inserted central catheters. J Vasc Access. 2022;23(1):166\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnnetta MG, Marche B, Giarretta I, Pittiruti M. Applicability and feasibility of intraprocedural tip location of femorally inserted central catheters by transhepatic ultrasound visualization of the inferior vena cava in adult patients. J Vasc Access. 2023:11297298231153979.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta N, Gandhi D, Sharma S, Goyal P, Choudhary G, Li S. Tunneled and routine peripherally inserted central catheters placement in adult and pediatric population: review, technical feasibility, and troubleshooting. Quant Imaging Med Surg. 2021;11(4):1619\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBroadhurst D, Moureau N, Ullman AJ. Management of Central Venous Access Device-Associated Skin Impairment: An Evidence-Based Algorithm. J Wound Ostomy Cont Nurs. 2017;44(3):211\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParienti J-J, Mongardon N, M\u0026eacute;garbane B, Mira J-P, Kalfon P, Gros A, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med. 2015;373(13):1220\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40(8):2479\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Tang S, Hu C, Zhang C, He L, Li X, et al. Femorally inserted central venous catheter in patients with superior vena cava obstruction: choice of the optimal exit site. J Vasc Access. 2017;18(1):82\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnnetta MG, Elli S, Marche B, Pinelli F, Pittiruti M. Femoral venous access: State of the art and future perspectives. J Vasc Access. 2023:11297298231209253.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIllig KA, Gober L. Optimal management of upper extremity deep vein thrombosis: Is venous thoracic outlet syndrome underrecognized? J Vasc Surg Venous Lymphat Disord. 2022;10(2):514\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGe X, Cavallazzi R, Li C, Pan SM, Wang YW, Wang FL. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev. 2012;2012(3):Cd004084.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNickel B, Gorski L, Kleidon T, Kyes A, DeVries M, Keogh S et al. Infusion Therapy Standards of Practice, 9th Edition. J Infus Nurs. 2024;47(1S Suppl 1):S1-s285.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHou J, Zhang J, Ma M, Gong Z, Xu B, Shi Z. Thrombotic risk factors in patients with superior vena cava syndrome undergoing chemotherapy via femoral inserted central catheter. Thromb Res. 2019;184:38\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang P, He L, Yuan Q, Lu J, Ji Q, Peng A, et al. Risk factors for peripherally inserted central catheter-related venous thrombosis in adult patients with cancer. Thromb J. 2024;22(1):6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarco S, Klok FA, Mah\u0026eacute; I, Marchena PJ, Ballaz A, Rubio CM, et al. Impact of sex, age, and risk factors for venous thromboembolism on the initial presentation of first isolated symptomatic acute deep vein thrombosis. Thromb Res. 2019;173:166\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoach REJ, Lijfering WM, Rosendaal FR, Cannegieter SC, le Cessie S. Sex Difference in Risk of Second but Not of First Venous Thrombosis. Circulation. 2014;129(1):51\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScrivens N, Sabri E, Bredeson C, McDiarmid S. Comparison of complication rates and incidences associated with different peripherally inserted central catheters (PICC) in patients with hematological malignancies: a retrospective cohort study. Leuk Lymphoma. 2020;61(1):156\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin MF, Thompson SM, Comstock AC, Levy ER, Reisenauer CJ, McPhail IR, et al. Technical success and safety of peripherally inserted central catheters in the great saphenous and anterior accessory great saphenous veins. J Vasc Access. 2022;23(2):280\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrescia F, Pittiruti M, Roveredo L, Zanier C, Morabito A, Santarossa E, et al. Subcutaneously anchored securement for peripherally inserted central catheters: Immediate, early, and late complications. J Vasc Access. 2023;24(1):82\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawes ML, McCormick CA, Gilbert GE. A retrospective study of subcutaneous anchor securement systems in oncology patients. J Vasc Access. 2023:11297298231190416.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrocoli A, Martucci C, Sidro L, Delle Donne D, Menna G, Pittiruti M, et al. Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study. J Vasc Access. 2023;24(1):35\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiustivi D, Donadoni M, Elli SM, Casella F, Quici M, Cogliati C, et al. Brachial Tunneled Peripherally Inserted Central Catheters and the Risk of Catheter Complications: A Systematic Review and Meta-Analysis. Nurs Rep. 2024;14(1):455\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZambetti BR, Kankaria A, Fang F, Kim N, Nagarsheth K, Sarkar R. Diameter and depth of femoral vessels by duplex ultrasound. J Vasc Access. 2023:11297298231200036.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Superior vena cava syndrome, Tunnelled femoral inserted central catheters, Oncology, Complications","lastPublishedDoi":"10.21203/rs.3.rs-5778445/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5778445/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSuperior vena cava syndrome (SVCS) is a critical condition that is often linked to malignancies and requires prolonged vascular access for therapeutic and palliative care. This prospective cohort analysis evaluated the long-term complications associated with tunneled femoral inserted central catheters (TFICCs) in adult oncology patients with SVCSs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a prospective cross-sectional study and was performed at a major cancer centre in China. The study involved oncology patients with SVCSs requiring central venous access via the TFICC from March 2022 to June 2022. A total of 89 adult oncology patients with SVCS who received TFICC placement were enrolled. The primary outcomes were the rates of TFICC-related complications, such as dislodgment, occlusion, blood reflux, catheter-related skin injury, catheter-related thrombosis, and unplanned removal. The secondary outcomes included the identification of risk factors associated with these complications. Univariate and binary logistic regression analyses were used to assess risk factors for complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNearly half of the patients (n = 42/89, 47.2%) experienced significant complications related to TFICC, with dislodgment emerging as the most prevalent issue at an alarming rate of 23.6%. It’s crucial to note that only a mere 5 patients (56%) had their catheters removed due to complications. The use of Power PICC-SOLO catheters was identified as a significant risk factor for occlusion. An increased catheter length reduces the risk of dislodgment, whereas a longer indwelling time increases this risk. A larger thigh circumference was linked to a greater chance of blood reflux.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTFICC placement in adult oncology patients with SVCSs is associated with a significant rate of complications, particularly concerning dislodgment. POWER PICC-SOLO is associated with a greater risk of occlusion. Catheter length and indwelling time influence the risk of dislodgment, and thigh circumference is a risk factor for blood reflux. These findings have implications for patient selection, catheter choice, and management strategies to minimize complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was registered at the Chinese Clinical Trial Registry on 21/02/2022 (registration number: ChiCTR2200055864).\u003c/p\u003e","manuscriptTitle":"Assessment of Long-Term Complications in Adult Oncology Patients with Superior Vena Cava Syndrome Receiving Tunnelled Femoral Catheters: A Prospective Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-15 12:02:24","doi":"10.21203/rs.3.rs-5778445/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-23T10:55:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-02T00:09:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-23T18:48:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-23T17:56:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291377495532594194632402696714212702914","date":"2025-02-23T17:26:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33665762145778211042819196733529911516","date":"2025-02-19T19:32:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327701565635225246435824590308039828105","date":"2025-02-18T17:37:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-17T19:27:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238124621472634921770831169945148640763","date":"2025-02-17T18:29:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129122519489607492945424482007962896019","date":"2025-02-16T22:25:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-16T17:05:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-01-16T11:31:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-16T05:14:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-09T11:44:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-01-07T06:28:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1df400bb-e880-4286-857a-4d263a5c27c2","owner":[],"postedDate":"January 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-11T08:08:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-15 12:02:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5778445","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5778445","identity":"rs-5778445","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}