Incidence Of Catheter-related Thrombosis Research Articles

Catheter-Related Thrombosis in Adults with Cancer: A Secondary Analysis of a Prospective Randomised Controlled Trial.

Catheter-related thrombosis (CRT) is a complication of central venous access devices (CVADs). Evidence is variable regarding the significance of the side of catheter insertion. The role of the patient's hand dominance in predisposition to CRT remains uncertain. In a prospective randomised controlled trial, adult cancer patients were randomly allocated to either dominant or non-dominant side CVAD insertion. The primary endpoint of this trial examined the incidence of catheter-associated blood stream infection. Here, we report the secondary endpoint of the incidence of CRT. 640 CVADs were randomised to the dominant (n=322) or non-dominant (n=318) side of insertion. Only symptomatic patients underwent ultrasound imaging to evaluate for CRT. The median patient age was 58, 60% of patients had haematological malignancies and 40% had solid tumours. CVADs used were peripherally-inserted central catheter line (PICC)(67%), tunnelled CVAD (23%) or non-tunnelled CVAD (10%). The CRT incidence rate was 0.65 vs 0.82 per 1000 line days in the dominant vs non-dominant group (HR 1.2; 95% CI 0.58-2.48, P=0.63). There was no significant difference in CRT incidence rate between left and right sided insertions (HR 0.63; 95% CI 0.30-1.32, P=0.22). The CRT incidence rate was lower in right-handed versus left-handed line inserters (HR 0.29; 95% CI 0.12-0.71, P=0.007). The rate of CRT was not associated with whether CVAD insertion was on the patient's dominant or non-dominant side or the side of insertion. The role of inserter hand dominance requires further investigation.

Catheter-related deep vein thrombosis: Where are we at and where are we going? Updates and ongoing unmet clinical needs.

Catheter-related thrombosis (CRT) is one of the major complications affecting patients with indwelling venous catheters, usually involving the upper extremity deep venous system. This condition can lead to potentially life-threatening complications such as pulmonary embolism and sepsis. The risk of developing CRT varies depending on type of catheters and patient characteristics. Despite advances in materials and technologies, the actual incidence of CRT is still considerable. Available evidence on CRT management remains controversial, and clinical guidelines base their recommendations on data from non-catheter related upper extremity or lower extremity deep venous thromboses. This narrative review aims to describe the epidemiology of CRT, to review the available evidence on its management and to highlight the current unmet needs. No formal search strategy was applied for the revision of the literature. The main sources of information used were Medline and guidelines from international societies. The management of CRT requires a careful balance between the risk of thrombus progression, recurrent events, and systemic embolization and the increased bleeding risk in often fragile patients. Open issues include the optimal management of the catheter and the type and duration of anticoagulant therapy. Direct oral anticoagulants are increasingly prescribed, representing an important alternative to the standard of care low molecular weight heparins in selected cases. The development of new anticoagulant drugs such as factors XI and XII inhibitors may offer further advantages in this context. The management of CRT is still challenging with constant need for updated evidence to support tailored approaches.

Comparison of complications and indwelling time in midline catheters versus central venous catheters: A systematic review and meta-analysis.

Central venous catheters and midline catheters are commonly used as medium- to long-term intravenous infusion tools in clinical nursing. However, there is currently no reliable conclusion on whether there are differences in complications and indwelling time between these two types of catheters. To investigate whether there are differences in the incidence of complications and indwelling time between the use of midline catheters and central venous catheters as intravenous infusion tools. A systematic search was conducted across various databases including Web of Science, PubMed, Embase, Cochrane Library, CINAHL, Wanfang and China National Knowledge Infrastructure. The selection of studies and assessment of their quality was carried out independently by two reviewers. Meta-analysis was conducted using the RevMan 5.3 software. Heterogeneity was evaluated, one of the pooled analyses was performed using the random-effect model, while the others used the fixed-effect model. Mean differences or odds ratios with corresponding 95% confidence intervals were calculated. Ten studies (1,554 participants) met the inclusion criteria. Meta-analysis showed that there was a statistically significant difference in the complication rates [OR = 0.36, 95% CI (0.18, 0.70), p = 0.003], incidence of catheter-related thrombosis [OR = 0.28, 95% CI (0.11, 0.71), I2= 0%,p = 0.007], catheter-related infection[OR = 0.36, 95% CI (0.16, 0.78), I2= 27%, p = 0.007] and catheter blockage [OR = 0.21, 95% CI (0.09, 0.51), I2= 18%, p = 0.0005] between midline catheters group and central venous catheters group. There was a statistically significant difference in the catheter indwelling time between the two groups [MD = 0.9, 95% CI (0.33, 1.46), I2= 0%, p = 0.002]. There was no significant difference in other complications such as phlebitis, catheter dislodgement and leakage between the two groups. Midline catheter was superior to central venous catheter in terms of the overall complication rates and incidence of catheter-related thrombosis, catheter blockage, catheter-related infection and indwelling time.

Different modes of ankle pump exercise to prevent PICC-related thrombosis through femoral vein.

To explore the preventive effect of different modes of ankle pump exercise on femoral vein PICC catheter-related thrombosis. Convenient sampling method was used to select 172 patients with lung cancer with PICC catheterization through femoral vein admitted to West China Hospital of Sichuan University as the observation group and control group. Comfort angle ankle pump exercise mode and maximum angle ankle pump exercise mode were adopted. We have compared the differences in the incidence of catheter-related thrombosis, unplanned catheter removal, fatigue score, and catheter retention time between two groups of patients. The incidence of catheter-related thrombosis, unplanned catheter removal, fatigue score, and catheter retention time were statistically significant (p < .05) in both groups of patients. The maximum angle ankle pump exercise mode can reduce the incidence of catheter-related thrombosis and unplanned catheter removal in patients with lung cancer with PICC catheterization through femoral vein, increase catheter retention time, but it can easily cause patient fatigue. In clinical practice, patient tolerance should be considered.

Incidence of catheter-related thrombosis and its association with outcome in critically ill patients: A prospective observational study

BackgroundIncidence of central venous catheter (CVC)-related thrombosis in critically ill patients remains ambiguous and its association with potential hazardous sequelae unknown. The primary aim of the study was to evaluate the epidemiology of CVC-related thrombosis; secondary aims were to assess the association of catheter-related thrombosis with catheter-related infection, pulmonary embolism and mortality. MethodsThis was a single-center, prospective observational study conducted at a tertiary intensive care unit (ICU) in the Netherlands. The study population consisted of CVC placements in adult ICU patients with a minimal indwelling time of 48 h. CVC-related thrombosis was diagnosed with ultrasonography. Primary outcomes were prevalence and incidence, incidence was reported as the number of cases per 1000 indwelling days. Results173 CVCs in 147 patients were included. Median age of patients was 64.0 [IQR: 52.0, 72.0] and 71.1 % were male. Prevalence of thrombosis was 0.56 (95 % CI: 0.49, 0.63) and incidence per 1000 indwelling days was 65.7 (95 % CI: 59.0, 72.3). No association with catheter-related infection was found (p = 0.566). There was a significant association with pulmonary embolism (p = 0.022). All 173 CVCs were included in the survival analysis. Catheter-related thrombosis was associated with a lower 28-day mortality risk (hazard ratio: 0.39, 95 % CI: 0.17, 0.87). ConclusionIn critically ill patients, prevalence and incidence of catheter-related thrombosis were high. Catheter-related thrombosis was not associated with catheter-related infections, but was associated with pulmonary embolism and a decreased mortality risk.

A prospective cohort study on rivaroxaban in the prevention of catheter-related thrombosis in breast cancer.

e12602 Background: Chemotherapy is an important treatment strategy for breast cancer. Catheter related thrombosis (CRT) is one of the most common complications of catheterization, affecting patients’ living quality and survival. It is thus of great practical significance for exploring how to prevent CRT. That’s why we carried out this study to provide evidence-based medical data for the prevention and treatment of thrombosis in breast cancer patients. Methods: A prospective cohort study approach was adopted. Breast cancer patients who received deep vein catheterization chemotherapy from July 2021 to July 2023 were selected. Cohort A included patients in the treatment group: they received prophylactic anticoagulation after catheterization: Rivaroxaban, 10 mg, orally once/d for 2 months; cohort B included patients in the control group, who did not receive prophylactic anticoagulation. The thrombosis was compared between the patients in the two groups within six months after catheterization. The comparison between groups was tested by X2 test, and logistic regression analysis was used to analyze the influencing factors of CRT. Results: A total of 402 breast cancer patients were enrolled. The incidence of CRT was 2.0% (4/201) in the treatment group of 201 cases and 12.4% (25/201) in the control group of 201 cases ( P=0.000). The thrombus was mainly located around the axillary vein, basilic vein and subclavian vein, the innominate vein, and the internal jugular vein. There were 44.8% (13/29) patients developed CRT within 30 days after catheterization, 20.7% (6/29) patients developed CRT within 30~&lt;60days, and 34.5% (10/29) patients developed CRT within 60~&lt;120 days. Patients diagnosed with CRT received anticoagulant therapy for 3 months. Within three months, the thrombus regression rate reached 100.0% (29/29). Univariate analysis showed that whether to receive prophylactic anticoagulation, whether hemoglobin is normal, patients whether to experience previous endocrine therapy, different Age group and chemotherapy regimens were actors for thrombosis, P&lt;0.05 respectively. Multivariate analysis indicated that age and whether to receive prophylactic anticoagulation were independent factors for thrombosis ( P=0.019, P=0.006, respectively). Patients diagnosed with CRT received deep vein cannulation while anticoagulation therapy was administered, with smooth infusion. They all completed antitumor therapy as planned, and no abnormalities such as new thrombosis and pulmonary embolism were found. Conclusions: The prophylactic anticoagulation regimen with Rivaroxaban can reduce the incidence of CRT in breast cancer, showing good efficacy and safety. Therefore, medical staff should carry out early prevention, early detection and early treatment for CRT to improve the living quality of patients. Clinical trial information: ChiCTR2000031649.

A retrospective study exploring the association of Covid-19 with the incidence of catheter-related thrombosis in inpatients receiving parenteral nutrition

A retrospective study exploring the association of Covid-19 with the incidence of catheter-related thrombosis in inpatients receiving parenteral nutrition

Mid-term analysis of prospective cohort study of rivaroxaban in preventing CRT in breast cancer

Objective: To explore the efficacy and safety of Rivaroxaban in preventing catheter related thrombosis (CRT) in patients with breast cancer who are undergoing central venous catheter chemotherapy, and provide basis for making standardized prevention and treatment strategies. Methods: In this research, a prospective cohort study was adopted, and breast cancer patients who received central venous catheter chemotherapy in Sanhuan Cancer Hospital during September 2020 to March 2022 were selected as a treatment group to take the rivaroxaban anticoagulation therapy with 10 mg.po.qd for one month. The control group got no preventive anticoagulation therapy. Vascular ultrasound examination was taken to confirm the occurrence of CRT, and a chi-square test was done for comparison the disparity between the groups. Logistic regression was applied to analyze the univariate and multivariate factors for the formation of CRT. Results: In the research, a total of 235 patients were selected, and there were a total of 19 035 days of catheterization with 81 days of catheterization on average. While in the control group, the incidence of CRT was 28.0% (33/118), the incidence of CRT in the treatment group was 20.5% (24/117), the difference was no significant (P=0.183). Subgroup analysis results showed that the peripherally inserted central catheter (PICC) was performed in 165 cases with the CRT incidence of 18.2% (30/165) and thrombosis was mostly seen around axillary vein, accounting for 63.3%. Subclavian vein catheterization was performed in 63 cases with the CRT incidence of 39.7% (25/63), and thrombosis was mostly seen around subclavian vein, accounting for 88.0% (22/25). Implantable venous access port was implanted in 7 cases around subclavian vein and internal jugular vein with the CRT incidence of 28.6% (2/7). The patients who developed CRT within 30 days after catheterization accounted for 54.4% (31/57), 22.8% (13/57) in a period during 30 days and 60 days) and 22.8% (13/57) in a period during 60 days and 180 days). The diagnosed CRT patients had been treated with rivaroxaban 15 mg.bid.po for 3 months. During the 3 months, 100.0% of the thrombosis waned, 71.9% (41/57) of the thrombosis waned within 30 days, 19.3% (11/57) in a period during 30 and 60days and 8.8% (5/57) in a period during 60 days and 90 days. Univariate and multivariate analysis indicated that the risk of CRT in subclavian vein catheterization was higher than that in PICC, respectively (OR=2.898, 95% CI:1.386-6.056 P=0.005), and the type of catheterization was an independent factor for the formation of thrombosis. Safety analysis result showed that in the prevention of CRT, rivaroxaban treatment did not induce drug-related bleeding, liver function damage, bone marrow suppression or any other side effects. While CRT diagnosed patients were treated with anticoagulation, they kept the central venous catheter, and the infusion was smooth. These patients all finished the anti-tumor treatment as planned, and no abnormalities like new thrombosis or pulmonary embolism were observed. Conclusions: In the mid-term analysis, the proportion of Rivaroxaban in preventing anticoagulant CRT decreases, but it don't reach statistical significance. The sample size should be further increased for observation. Rivaroxaban is proved effective and very safe in the treatment of CRT, and does not affect the concurrent chemotherapy. Medical personnel should carry out the policy of "early prevention, early detection and early treatment" for CRT so as to improve the patients' quality of life.

Clinical Factors Associated with Catheter-Related VTE in Patients Undergoing Hematopoietic Cell Transplantation

Introduction: In patients undergoing allogeneic hematopoietic cell transplantation (HCT), venous thromboembolism (VTE) is associated with increased morbidity and worse survival. Central venous catheters (CVC) are placed for administration of both stem cell products and other supportive measures. CVC are a common etiology of VTE during HCT. This study examines the associations between patient- and CVC-related variables and the incidence of catheter-related thrombosis (CRT) in patients undergoing allogeneic HCT. Methods: We selected consecutive patients who underwent their first allogeneic HCT from MD Anderson Cancer Center between 2016-2020. The electronic medical records (EMR) of these patients were examined using ICD 9/10 codes, and radiology reports using a natural language processing (NLP) algorithm to look for VTE events. All VTE events were confirmed via manual chart review. Details on the type of CVC, anatomic venous location, laterality, and size were extracted. For this study, CVC was defined as a catheter that extends into the superior vena cava; these catheters were classified as either a peripherally induced central catheter (PICC), non-tunneled CVC, or tunneled CVC. Unadjusted and multivariable Cox proportional hazards models were used to assess the association between patient and transplant factors and time to CRT. Acute graft versus host disease and active infection were included in the models as categorical time varying covariates. Cumulative incidence competing risk model was used to assessed CRT incidence with death as a competing cause. Results: There were 1371 adult patients included in the study. Most patients had non-tunneled CVC as their central access, with the subclavian vein being the most used location (Table 1). A total of 207 patients had VTE during the first year post-HCT, with 153 having isolated CRT and 54 having other VTE (Table 1). The incidence of CRT was 7.7% at 100-day and 11.3% at 1-year, with the incidence rate at a near constant estimate in the first 100 days. The cumulative incidence of DVT/PE with death as a competing risk factor was 1.17% at 100-day and 4.08% at 1-year. In Cox regression models for CRT by 100 days, history of VTE, higher platelet count, acute GVH disease stage 3-4, and infection were statistically associated with time to CRT (Table 2). The type of CVC (non-tunneled CVC and PICC vs. tunneled CVC) was non-significantly associated with increased risk of CRT. Conclusion: In our cohort of patients undergoing allogeneic HCT, the incidence of CRT appeared to be higher than that reported in the literature. Significant risk factors associated with CRT occurred included VTE history, higher pre-transplant platelet count, and development of severe acute GVHD or active infection. While the type of CVC did not reach statistical significance due to the majority of patients receiving non-tunneled CVC as a standard institutional practice, there was a trend of increased CVC in this group of patients. Future multi-center studies that incorporate different types of CVC will further elucidate this potential association with CRT post-transplant.

Postoperative intermittent pneumatic compression for preventing venous thromboembolism in Chinese lung cancer patients: a randomized clinical trial

BackgroundPostoperative lung cancer patients belong to the high-risk group for venous thromboembolism (VTE). The standardized preventive measures for perioperative VTE in lung cancer are not perfect, especially for the prevention and treatment of catheter-related thrombosis (CRT) caused by carried central venous catheters (CVCs) in lung cancer surgery.Patients and methodsThis study included 460 patients with lung cancer undergoing video-assisted thoracic surgery (VATS) in our center from July 2020 to June 2021. Patients were randomized into two groups, and intraoperatively-placed CVCs would be carried to discharge. During hospitalization, the control group was treated with low-molecular-weight heparin (LMWH), and the experimental group with LMWH + intermittent pneumatic compression (IPC). Vascular ultrasound was performed at three time points which included before surgery, before discharge, and one month after discharge. The incidence of VTE between the two groups was studied by the Log-binomial regression model.ResultsCRT occurred in 71.7% of the experimental group and 79.7% of the control group. The multivariate regression showed that the risk of developing CRT in the experimental group was lower than in the control group (Adjusted RR = 0.889 [95%CI0.799–0.989], p = 0.031), with no heterogeneity in subgroups (P for Interaction > 0.05). Moreover, the fibrinogen of patients in the experimental group was lower than control group at follow-up (P = 0.019).ConclusionIPC reduced the incidence of CRT during hospitalization in lung cancer patients after surgery.Trial registrationNo. ChiCTR2000034511.

Heparinized Saline Flushed Catheter May Reduce Risk of Thrombosis in Cancer Patients Received Chemotherapy with Peripherally Inserted Central Catheter

Objective: This study investigated the effect of heparinized saline flushed catheter on preventing catheter-related thrombosis (CRT) among cancer patients received peripherally inserted central catheter (PICC) for chemotherapy. Background: CRT is a common and serious complication when using PICC, which is one of the most commonly used vascular access devices for drug infusion, intravenous nutrition, and chemotherapy. Methods: This prospective, paralled-group trial enrolled 300 cancer patients received chemotherapy who were randomly assigned to the intervention (n=150) or control (n=150) group. Besides the basic procedure of PICC combined with IC- ECG and B-mode ultrasound imaging, heparinized saline flushed catheters were used in the intervention group, while normal saline flushed ones were used in the control group. Hemorheology tests and tip sites measurements were used in outcome evaluation, and the incidences of CRT and other complications. In additions, thromboelastogram (TEG) were used to measure thrombus elastic before and one week after PICC. Results: 148 patients in the intervention group and 138 patients in the control group finished PICC and follow-ups, which indicating longer duration and more completion of PICC with better catheter tip positioning in the intervention group. Intervention subjects showed significant lower incidences of CRT and other complications (phlebitis, catheter blockage, catheter prolapse, and local infection) (P <.05). In additons, our proposed method may reduce CRT incidence via significantly improving blood circulation among patients received chemotherapy via PICC. Conclusion: Heparinized saline flushed catheter may increase chemotherapy completion quality via PICC, reduce the risk of catheter-related thrombosis complications, and reduce CRT incidence via improving blood circulation. Conclusions: This proposed method can be easily introduced to prolong the duration of the placement and improve the blood circulation of cancer patients received PICC.

Evaluation of venous thromboembolism risk factors reveals subtype heterogenicity in children with central venous catheters: a multicenter study from the Children’s Hospital Acquired Thrombosis consortium

BackgroundAcutely ill and medically complex children frequently rely on central venous catheters (CVCs) to provide life-sustaining treatment. Unfortunately, catheter-related thrombosis (CRT) is a serious and common complication. Little is known why some with a CVC develop CRT and others develop venous thromboembolism unrelated to the CVC (non-CRT). ObjectivesThe aim of this study was to identify factors associated with CRT in children with hospital-acquired venous thromboembolism (HA-VTE). MethodsThis case-case study included participants in the Children’s Hospital Acquired Thrombosis Registry with HA-VTE and CVC aged 0 to 21 years from 8 US children’s hospitals. Participants were excluded if they developed HA-VTE prior to CVC insertion or if the CVC insertion date was unknown. Logistic regression models were used to assess associations between clinical factors and CRT status. ResultsThere were 1144 participants with HA-VTE who had a CVC. CRT developed in 833 participants, and 311 developed non-CRT. Multivariable analysis showed increased odds of CRT (compared with non-CRT) in participants with peripherally inserted central catheters (odds ratio [OR], 3.80; 95% CI, 2.04-7.10; p < .001), CVCs inserted in the femoral vein (OR, 4.45; 95% CI, 1.70-11.65; p = .002), multiple CVCs (OR, 1.42; 95% CI, 1.18-1.71; p < .001), and CVC malfunction (OR, 3.30; 95% CI, 1.80-6.03; p < .001). ConclusionThe findings of this study provide new insights on risk factor differences between CRT and non-CRT. Prevention efforts should be directed at modifying the type of CVC, insertion location, and/or number of CVCs placed, if possible, to decrease the incidence of CRT.

Risk factors for central venous catheter-related thrombosis in hospitalized children: a single-center a retrospective cohort study.

This study aimed to explore the risk factors of catheter-related thrombosis (CRT) in children in Southwest China who underwent central venous catheter (CVC) insertion. An observational cohort study was conducted at a single tertiary center in southwest China between November 2019 and February 2020. All patients who received a CVC were enrolled and Doppler-ultrasound examination was performed weekly until CVC removal. All patients in this study were hospitalized and were observed and followed up in this hospital. Patient demographics, medication, biochemical indexes, catheter maintenance practice, activities after CVC placement data were analyzed. The Kaplan-Meier method was used to calculate the incidence of CRT, and the Cox regression model was used to analyze the factors influencing CRT. A total of 594 children were included in the study, and the median indwelling time was 10 days, with the shortest being 1 day and the longest 60 days. The overall incidence of CRT was 26.60% (158/594), the 15-day cumulative incidence rate was 30.81%, and the 45-day cumulative incidence rate was 46.27%. After 45 days, the incidence of CRT further increased. Age <12 months [hazard ratio (HR), 1.654; 95% confidence interval (CI): 1.171-2.338], use of 20% mannitol or glycerol fructose (HR, 1.593; 95% CI: 1.058-2.398), CVC placement by a pediatric intensive care unit (PICU) doctor (HR, 1.921; 95% CI: 1.347-2.740), placement length ≥9 cm (HR, 1.633; 95% CI: 1.142-2.336), and D-dimer >1.5 mg/L (HR, 1.451; 95% CI: 1.044-2.015) were risk factors for CRT. Limb exercises (HR, 0.660; 95% CI: 0.469-0.929) after placement was a protective factor for CRT. The incidence of CRT was higher in children with CVCs, and the key duration of CRT monitoring should be within 15 and 45 days after placement. Patients with age <12 months, using 20% mannitol or glycerol fructose, insertion length ≥9 cm, D-dimer >1.5 mg/L before placement are more likely to happen CVC-CRT than other patient, and it is necessary to be highly vigilant and take preventive measures.

Conditional catheter-related thrombosis free probability and risk-adapted choices of catheter for lung cancer.

BackgroundCurrent predictive tools assess catheter‐related thrombosis (CRT) in patients with lung cancer in a static manner at a single time point of catheterization. The subsequent hazard changes over time are unknown. The conditional catheter‐related thrombosis‐free probability (CCFP) can provide dynamic information on continual CRT‐free expectations. This study aimed to assess the CCFP and hazard rates based on risk categories and various venous access devices (VADs).MethodsThis retrospective study reviewed 939 patients with lung cancer with peripherally inserted central venous catheters (PICCs) or central venous catheters (CVCs) identified at the National Clinical Research Center for Cancer between January 1, 2015 and December 31, 2018. The incidence of CRT has also been reported. Patients were stratified into low‐ and high‐risk groups according to multivariate Cox regression analyses. CCFP is defined as the CRT‐free probability given that patients have no CRT for a definite time.ResultsA total of 507 patients with PICCs and 432 patients with CVCs were included in this study. The 3‐month CCFP increased from 74.2% at catheter insertion to 93.6% at 3 months. The hazards of CRT in the first month were highest (16.4%) and slightly thereafter. The high‐risk group initially had a higher (21.4%) but significantly decreased CRT hazard after 2 months (8.3%), whereas the low‐risk group maintained a comparable lower risk hazard of less than 5% after 1 month. In the overall cohort, patients with CVCs had lower CRT probability than those with PICCs (HR, 1.76; 95% CI: 1.28–2.41; p < 0.01). Further analysis demonstrated that compared with PICCs, CVCs provided a CRT‐free benefit in low‐risk patients (p = 0.02) but not in high‐risk patients (p = 0.06).ConclusionsCCFP increased, and the hazards of CRT decreased over time in a risk‐dependent manner in patients with lung cancer. These valuable dynamic data may help optimize risk‐adjusted choices of VADs and risk‐adjusted prophylactic anticoagulation strategies for patients.

Prophylactic anticoagulation in children receiving home parenteral nutrition.

Children with intestinal failure (IF) are at risk of loss of vascular access because of catheter-related venous thrombosis. Whether primary prophylactic anticoagulation is effective and safe in preventing catheter-related thrombosis is largely unknown. Our aim was to assess the incidences of catheter-related venous thrombosis and bleeding complications in children with IF receiving home parenteral nutrition (HPN) treated with primary prophylactic anticoagulation. All children, aged 0-18 years, treated with HPN at the Emma Children's Hospital/Amsterdam UMC were followed from January 2007 to July 2019. All patients were offered primary prophylactic anticoagulation from the start of HPN. The primary outcomes were catheter-related venous thrombosis and bleeding on prophylactic anticoagulation. In total, 55 (76%) of 74 patients received primary prophylactic anticoagulation. The median age at the start of prophylaxis was 8.4 (interquartile range [IQR], 5.0-55.7) months. Patients were followed for a median of 31.2 (IQR, 10.7-53.5) months, with a total of 65,463 catheter days. The incidence of catheter-related thrombosis on prophylactic anticoagulation was 0.2 per 1000 catheter days. In total, the incidence of clinically relevant bleeding was 0.1 per 1000 catheter days. The median time to first event was 1268 (IQR, 149-2014) days for thrombosis and 389 (IQR, 227-2912) days for clinically relevant bleeding. Cumulative event-free survival after 5 years was 78% for thrombosis. Our study shows a low rate of catheter-related venous thrombosis and a slightly elevated rate of clinically relevant bleeding in children receiving HPN and primary prophylactic anticoagulation.

Catheter-related thrombosis after cardiac surgery in patients with both central venous and pulmonary artery catheters inserted into the right internal jugular vein: a single-center, prospective, observational study.

Central venous catheters (CVCs) and pulmonary artery catheters (PACs) are widely used in intensive care and perioperative management. The detection and prevention of catheter-related thrombosis (CRT) are important because CRT is a complication of catheter use and can cause pulmonary embolism and bloodstream infection. Currently, there is no evidence for CRT in patients using both CVC and PAC. We conducted a single-center, prospective, observational study to identify the incidence, timing, and risk factors for CRT in patients undergoing cardiovascular surgery and using a combination of CVC and PAC through the right internal jugular vein (RIJV). Out of 50 patients, CRT was observed using ultrasonography in 39 patients (78%), and the median time of CRT formation was 1day (interquartile range: 1-1.5) after catheter insertion. The mean duration of PAC placement was 3days (interquartile range: 2-5), and the maximum diameter of CRT was 12mm (interquartile range: 10-15). In short-axis images, CRT occupied more than half of the cross-sectional area of the RIJV in five patients (10%), and CRT completely occluded the RIJV in one patient (2%). Platelet count, duration of PAC placement, and intraoperative bleeding amount were found to be high-risk indicators of CRT. In conclusion, patients who underwent cardiovascular surgery and using both CVC and PAC had a high incidence of CRT. Avoiding unnecessary PAC placement and early removal of catheters in patients at high risk of developing CRT may prevent the development of CRT.

A comparative study on the tip position of peripherally inserted central catheter inserted at two forward P-wave amplitudes by intracavitary electrocardiogram in cancer patients.

This study aimed to compare the tip location of peripherally inserted central catheter (PICC) under two forward P-wave amplitudes (P-wave amplitude is the autonomous peak or P-wave amplitude is 50-80% of the QRS main wave) by intracavitary electrocardiogram (IC-EKG) to determine the PICC tip in optimal location thus avoiding catheter-related complications. The data of 300 cancer patients with PICC insertion were collected retrospectively. For the observation group, the position of the catheter tip was left at the level when P wave amplitude was its autonomous peak (168 patients catheterized in 2018). While for the control group, the catheter tip was left at the level when the P wave amplitude was 50-80% of the QRS main wave (132 patients catheterized in 2017). Both groups of patients underwent the chest X-ray examination (CXR) after catheterization. The total compliance rate [PICC tip was located in the lower third of the Superior Vena Cava (SVC) and the Cavo-Atrial Junction (CAJ)], the optimal position compliance rate (PICC tip was located in the CAJ), and the incidence of the catheter tip malposition were compared between the two groups. The complications after catheterization including arrhythmia after catheterization within 24 hours, catheter-related thrombosis, catheter dysfunction, and catheter infection within 90 days were also compared. There was no difference in the total compliance rate of PICC tip position and the incidence of the catheter malposition in the two groups (P>0.05). But the optimal position compliance rate of the observation group was higher than that of the control group (P<0.05). There was no difference in the incidence of arrhythmia after catheterization within 24 hours of the two groups (P>0.05). The incidence of catheter-related thrombosis, catheter dysfunction, and catheter infection within 90 days in the observation group was lower than those in the control group (P<0.05). The PICC tip position at the autonomous peak of the P wave is significantly better than that at the P wave amplitude being 50-80% of the QRS main wave under the IC-EKG guidance for PICC insertion.

Risk Factors for Catheter-Related Thrombosis in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation.

Background and Objectives: Cancer associated thrombosis (CAT) is a common complication of neoplasms. Multiple myeloma (MM) carries one of the highest risks of CAT, especially in the early phases of treatment. Autologous stem cell transplantation (ASCT) as the standard of care in transplant-eligible patients with MM carries a risk of catheter-related thrombosis (CRT). The aim of this study was identification of the risk factors of CRT in MM patients undergoing ASCT in 2009–2019. Materials and Methods: We retrospectively analyzed patients with MM undergoing ASCT. Each patient had central venous catheter (CVC) insertion before the procedure. The clinical symptoms of CRT (edema, redness, pain in the CVC insertion area) were confirmed with Doppler ultrasound examination. We examined the impacts of four groups of factors on CRT development: (1) patient-related: age, gender, Body Mass Index (BMI), obesity, Charlson comorbidity index, hematopoietic stem cell transplantation comorbidity index, renal insufficiency, and previous thrombotic history; (2) disease-related: monoclonal protein type, stage of the disease according to Salmon–Durie and International Staging System, number of prior therapy lines, and MM response before ASCT; (3) treatment-related: melphalan dose, transplant-related complications, and duration of post-ASCT neutropenia; (4) CVC-related: location, time from placement to removal. Results: Symptomatic CRT was present in 2.5% (7/276) of patients. Univariate analysis showed an increased risk of CRT in patients with a catheter-related infection (OR 2.4, 95% CI; 1.109–5.19, p = 0.026), previous thrombotic episode (OR 2.49, 95% CI; 1.15–5.39, p = 0.021), previous thrombotic episode on initial myeloma treatment (OR 2.75, 95% CI; 1.15–6.53, p = 0.022), and gastrointestinal complications of ASCT such as vomiting and diarrhea (OR 3.87, 95% CI; 1.57–9.53, p = 0.003). In multivariate analysis, noninfectious complications were associated with higher CRT incidence (OR 2.75, 95% CI; 1.10–6.19, p = 0.031). Conclusions: The incidence of symptomatic CRT in ASCT in MM was relatively low. Previous thrombotic events, especially during the induction of myeloma treatment, increased CRT risk during ASCT. Dehydration following gastrointestinal complications may predispose to higher CRT incidence.

Exploration of the high-risk factors of catheter-related thrombosis in breast cancer

Objective: To explore the high risk factors of catheter-related thrombosis (CRT) in breast cancer patients, and provide the basis for the development of appropriate prevention and treatment strategies. Methods: A total of 1 432 breast cancer patients scheduled to receive central venous catheterization in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2015 to August 31, 2019 were selected. Baseline information and catheterization information of patients were collected. The occurrence of CRT was confirmed by vascular ultrasound examination, and the influencing factors of CRT were analyzed. Results: The total number of catheter days were 121, 980 days in 1 432 patients with breast cancer, and the average number of catheter days in each patient was 85.2 days. The incidence of CRT was 6.8% (97/1 432), which was 0.79 cases/1 000 catheter days. Among 815 patients with centrally inserted central venous catheters (CICC), 43 (5.3%) had CRT, which was 0.70 cases/1 000 catheter days. Among 617 patients with peripherally inserted central venous catheters (PICC), 54 (8.8%) developed CRT, which was 0.90 cases/1 000 catheter days. CRT was most common in subclavian vein (63.9%). Multivariate regression analysis showed that age ≥ 60 years old (OR=1.712, 95% CI: 1.056-2.775, P=0.029), PICC (OR=1.732, 95% CI: 1.130-2.656, P=0.012), the catheter position except subclavian vein (OR=10.420, 95% CI: 1.207-89.991), secondary adjustment of catheter position (OR=3.985, 95% CI: 1.510-10.521, P=0.005) and high D-Dimer level (OR=1.129, 95% CI: 1.026-1.241, P=0.012)were independent risk factors for CRT. Conclusions: The CRT problem can't be ignored in the clinical treatment of breast cancer patients with central venous catheterization. Screening the appropriate age of patients and the type of central venous catheters, reducing the secondary adjustment of catheter position, and timely monitoring the level of D-dimer are helpful to the prevention and treatment of CRT.

Catheter-Related Thrombosis in Patients with Lymphoma or Myeloma Undergoing Autologous Stem Cell Transplantation

Background: Catheter-related thrombosis (CRT) occurs frequently during autologous hematopoietic cell transplantation (AHCT) and its current management is highly variable. There is limited data regarding the incidence, risk factors, management patterns and outcomes of CRT in patients with lymphoma or myeloma undergoing AHCT.Methods: In a retrospective observational study with nested case-control risk factor analysis, we examined 789 patients with lymphoma and myeloma who underwent AHCT at University of Minnesota between 2006-2016. We identified 50 subjects with CRT from central venous catheters (CVCs). Patient and transplant characteristics and outcomes were compared in the case-control analysis with 2:1 matching by patient age and disease. All AHCT recipients underwent insertion of tunneled 14.5fr double lumen large bore tunneled catheters for hematopoietic cell apheresis. All patients underwent routine CT chest prior to AHCT and at days 28 and 100 post-transplant. The primary objective was to describe the CRT incidence, management and complications. Secondary objective was to identify CRT risk factors. Statistical comparison of categorical variables was performed by χ2 and Wilcoxon rank-sum test was used for assessment of continuous variables between cases and controls.Results: The incidence of CRT in patients with lymphoma and myeloma undergoing AHCT over the ten-year period was 6.3% (n=50); with 32% symptomatic. Out of 50 cases, 43 occurred within 100 days of AHCT and 94% cases were associated with tunneled line; predominantly internal jugular (90%). CRT was diagnosed between 21 days prior to 26 days after CVC insertion. Five patients had pulmonary embolism detected incidentally by CT imaging; all were asymptomatic. The median time from tunneled line placement to CRT was 44 days (11-89 days) Of the 50 patients with CRT, 22% had refractory Hodgkin's lymphoma (incidence in HL 11.0%), 62% non-Hodgkin's lymphoma (incidence in NHL 10.1%) and 16% myeloma (incidence in MM 2.1%). The median age at the time of CRT was 56.6 years; 60% were male. Prior radiation to chest/neck (18%), bulky mediastinal mass (12%), splenectomy (6%), bacteremia (18%), hormonal therapy (8%), and prior VTE (16%) were common amongst CRT cases. Half of CRT cases had a Port-a-cath and 46% had more than one CVC inserted peritransplant. Vein occlusion was complete in 46% and occurred with the same frequency on left and right (44% vs 42%). At the time of CRT, median platelet count was 133 (range 31-426 x 109/L). Median time of tunneled line removal was 0 days (ie. on same day as CRT) but ranged from 21 days before CRT to 161 days after CRT.Most (86%) CRTs were treated with low molecular weight heparin (LMWH) and 56% received subsequent warfarin. Only 2% were treated with unfractionated heparin. LMWH at dose 1 mg/kg twice daily was administered if platelet count could be maintained above 50 x 109/L and median time to platelet recovery was 15 days (range 9-36). Patients were anticoagulated for <3 months (38%), 3-6 months (24%), and >6 months (22%). One patient required lytic therapy for CRT. Only two patients (4%) received secondary prophylactic anticoagulation after AHCT. This management was safe and effective and grade 1-2 bleeding events occurred in only two patients (4%) during anticoagulation. Five patients (10%) had CRT recurrence or extension while 12% had subsequent VTE after CRT. No deaths occurred due to CRT or its treatment.In univariate analysis, risk factors for CRT included prior VTE event (20.9% vs 7.0%, p=0.02) and higher WBC peak at mobilization (43.5 vs 40.4 x 109/L, p=0.17) and stem cell engraftment (15.2 vs 11.9 x 109/L, p=0.18). Gender, presence of Port-a-cath, comorbidity index and Karnofsky score did not increase the risk of CRT. Two-year progression-free survival of entire group was 54% (95% CI 50-57%) and was not affected by CRT (p=0.42).Conclusions: The diagnosis of CRT complicates AHCT and appears to be more common in patients with lymphoma than myeloma. Prior VTE is the main risk factor for CRT. Anticoagulation with LMWH or warfarin appeared safe , however many patients had recurrent VTE events. Higher WBC seems to be associated with risk of thrombosis. Further study to define additional risk factors and examine the management strategies is warranted. DisclosuresBachanova:Seattle-Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Zymogen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Oxis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Juno: Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding.