Abstract
AimsPeripherally inserted central catheters(PICC) lines are becoming increasingly popular in solid cancer patients for the administration of chemotherapy. This study aims looking at the incidence of PICC line related and distant thromboembolism associated with these catheters and exploring risk factors.MethodsRecords were reviewed for 158 patients who underwent PICC line insertion over the two years period in the medical oncology unit, Milton Keynes University Hospital. The Incidence PICC line related Deep Venous Thrombosis (DVT) which is defined as upper extremity DVT at the site of PICC line insertion was documented after checking reports of ultrasound Doppler of all symptomatic patients to confirm the presence of thrombo-embolism and Computed Tomography(CT)scan or Computed Tomography Pulmonary Angiography (CTPA) to confirm the presence Pulmonary Embolism(PE).Results23(13%) symptomatic patients with confirmed diagnosis by ultrasound Doppler were found to have PICC line related DVT and similar number of patients developed distant VTE, namely PE and lower limbs DVT. Average time to thrombo-embolism from the insertion of PICC line was 13 days and 51 days in distant VTE. Statistically significant results have been identified in the term of risk factors leading to VTE events during the period of PICC line insertion.ConclusionsVTE is a common complication in medical oncology patients who underwent insertion PICC line insertion for chemotherapy. Risk of distant VTE is high as well as the PICC line related DVT and the risk of the PICC line related DVT is higher in the first two weeks after PICC insertion. We concluded that high BMI,high PLTs count and Fluropyrimidine containing chemotherapy are all significant risk factors for VTE events recorded while smoking and high BMI are significantly contributing to the high rate of the PICC line related DVT.
Highlights
The use of Peripheral Inserted Central Catheter (PICC) line has grown significantly in hospitalized patients in comparison with central venous catheters reflecting their clinical advantages besides avoiding iatrogenic complications frequently associated with central venous catheters [1, 2]
Total of 180 patients were retrospectively evaluated for PICC insertion. 22 patients have been excluded due to incomplete data.158 patients with completed data were found eligible for analysis
The distribution of distant Venous Thromboembolism (VTE) was 18(78%) patients as Pulmonary Embolism (PE) while the lower limbs Deep Venous Thrombosis (DVT) recorded in only 5(22%) patients
Summary
The use of PICC line has grown significantly in hospitalized patients in comparison with central venous catheters reflecting their clinical advantages besides avoiding iatrogenic complications frequently associated with central venous catheters [1, 2]. The incidence of PICC related VTE varies widely in different studies, with the symptomatic VTE in this scenario is reported to be varying around 6% to up to 18% and in few studies, it was around 25% [1, 3] while the rate of asymptomatic thrombosis has been reported to be up to 35–71.9% [14–18]. Many of these studies use a retrospective design and the actual rate of PICC related DVT is still not well defined. In our study we analyse our experience with PICC insertion in the ambulatory solid cancer patient’s population and measure the incidence of local, distant VTE events and relative risk factors
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