Incidence Of PICC-related Thrombosis Research Articles

Predictive Value of Red Cell Distribution Width in the Diagnosis of Peripherally Inserted Central Catheter (PICC)-Related Thrombosis Among Cancer Patients.

This study aimed to investigate the predictive value of red cell distribution width (RDW) in patients with peripherally inserted central catheter (PICC)-related thrombosis. This was a case‒control study. A total of 98 cancer patients undergoing PICC placement from January 2017 to December 2019 at the ICU Venous Access Center of Peking University Cancer Hospital were retrospectively analyzed. These included 47 cases in the thrombosis group and 51 cases in the nonthrombosis group according to the occurrence of PICC-related thrombosis within 90 days after the PICC procedure. a) RDW was significantly higher in the thrombosis group (15.98±1.93) than in the nonthrombosis group (13.98±1.09). Additionally, the number of smoking histories in the thrombosis group (18, 38.30%) was significantly higher than that in the nonthrombosis group (5, 9.80%). b) Logistic regression analysis indicated that RDW and smoking history were independent risk factors for PICC-related thrombosis (OR: 3.028, P<0.001; OR: 5.640, P=0.023). c) The area under the receiver operating characteristic (ROC) curve of the combination of RDW and smoking history was 86.8%, and the sensitivity and specificity for predicting thrombosis after PICC were 85.1% and 80%, respectively. d) Cox regression analysis revealed that RDW and smoking history were independent risk factors for PICC-related thrombosis (p<0.001). e) Results from Kaplan‒Meier analysis showed that incidence of PICC-related thrombosis in patients with RDW less than 14.75% is significantly lower than those with RDW 14.75% and above (p<0.001). e) Baseline RDW was not different between the two groups (P>0.05), ΔRDW was significantly different between the two groups (p<0.001). The combined use of RDW and smoking history has early evaluation and predictive value in the diagnosis of PICC-related thrombosis.

P1608: EXPERIENCE AND COMPLICATIONS WITH THE USE OF PICCS IN HEMATOLOGIC PATIENTS

Background: In the last few years the widespread use of peripherally inserted central catheter (PICCS) has provided a benefit for patients with hematological disorders. PICCS can be used for administration of supportive therapy, chemotherapy or parenteral nutrition. In some cases, they represent a better alternative to other catheters because of their easier and safer insertion/removal and its capacity to provide long-term venous access. Nevertheless, infection and thrombosis are two of the main complications associated with their use, but their rates and risk factors are highly variable. Aims: To review the experience with PICCs in patients with hematologic diseases as well as to describe and analyze the possible complications associated with their use. Methods: This is a retrospective unicenter study that included all adult patients with hematologic diseases that required a PICC insertion between June 2019 and December 2021. This procedure was performed by specifically trained nurses, who from this date began to tunnel PICCs guided by ultrasonography, at our hospital day care units. These nurses were in charge of weekly monitoring and cleaning the devices. Demographic and clinical data were obtained from the electronic medical records. Results were analyzed using SPSS Statistics program (v.21). Results: A total of 99 PICCs were inserted into 82 different patients (68 (1 PICC); 12 (2PICCs); 1 (3 PICCs); 1 (4 PICCs)). Table 1.a summarizes baseline characteristics of the cohort. The median duration of the devices was 123 days (interquartile range (IR) 48-176) with 13,203 in situ days. By the time of this analysis, 87 PICCs have been removed. The reasons for PICC insertion and removal are shown in Table 1.b. Interestingly, 41.4 % of the PICCs were inserted in patients receiving any type of antithrombotic therapy due to their underlying condition (low molecular weight heparin= 31.3%; oral anticoagulation=7.1% and low dose aspirin=3%). The incidence of PICC related thrombosis (PRT) was 4.04% with a rate of 0.30/1000 PICC days. One PICC was removed after the diagnosis of PRT, 2 could be safely maintained until end of treatment and 1 patient died due to disease progression 3 days after PRT. No patient had thrombus progression. All PRT occurred in patients that were not receiving antithrombotic therapy. Hodgkin lymphoma (HL) compared with other diagnosis was found as the only significant risk factor for PRT (p=0.03). The incidence of PICC related infection (PRI) was 7.1% with a rate of 0.53/1000 PICC days. The median onset of PRI was 22 days (IR 4-89) and 6/7 PICCs were removed after PRI. Microbial isolates of PIIC bloodstream infections were: Coagulase-negative staphylococci (N=5); Staphylococcus aureus (N=1); Bacillus thuringiensis (N=1). Age (p=0.4); sex (p=0.8); type of disease (p=0.8); steroid use (p=0.9)/neutropenia (p=0.4) at the time of line placement; parenteral nutrition (p=0.1); type of PICC (p=0.8) and days with PIIC (p=0.5) were not significant risk factors for PRI. No early PICC-related complications were documented and PICC complications were not the primary cause of death for any patient. Image:Summary/Conclusion: In our experience, PICCs are safe devices for patients with hematological diseases and can be used for a prolonged period. We did not find early complications during PICC insertion. We found a low rate of PRT, with a higher predisposition in HL patients. A favorable low rate of PRI was also observed in this series which could be explained by the adequate management of the devices at our institution with a weekly follow-up nurse control.

Feasibility analysis of external application of Xiao-Shuan-San in preventing PICC-related thrombosis

PurposeWe aim to analyze the feasibility of external application of Xiao-Shuan-Santo prevent peripherally inserted central catheter (PICC) -related thrombosis. MethodsA total of 218 patients with PICC catheterization were randomly divided into a control group (n = 103) and a treatment group (n = 115). Patients in the treatment group received additional external application of Xiao-Shuan-San. The changes of coagulation index, the incidence of PICC-related thrombosis and other complications, and the maximum blood flow rate (Vmax) of axillary vein were observed at 1 day before catheterization and 30 days after PICC. ResultsAt 30 days after PICC, the incidence of PICC-related thrombosis and other adverse events in the treatment group were obviously lower than that in the control group (P < 0.05), and the decreased Vmax value of axillary vein in the control group (11.75±1.91 cm/s) was more visible than that in the treatment group (14.63±3.03 cm/s), accompanied by a statistical significance (P < 0.05). ConclusionsExternal application of Xiao-Shuan-San could reduce the incidence of PICC-related thrombosis and other complications.

PICC‐RELATED THROMBOSIS IN PATIENTS WITH AGGRESSIVE LYMPHOMA TREATED WITH DA‐EPOCH—HOW TO PREVENT IT?

Introduction: Peripherally inserted central catheters (PICCs) are long-term catheters appropriate for administration of continuous infusions such as DA-EPOCH protocol. The main complications associated with PICC-lines are infections and PICC-related thrombosis. Data on the incidence and prevention of PICC-related thrombosis in patients with lymphoma are limited. In this study, we investigated the role of antithrombotic prophylaxis in patients with aggressive non-Hodgkin lymphoma (NHL) treated with DA-EPOCH ± rituximab (DA-EPOCH ± R). Methods: From September 2009 to March 2017, 95 patients with newly diagnosed aggressive NHL were treated with DA-EPOCH ± R regimen at our institution. A single lumen 5Fr PICC was used in all patients. Antithrombotic prophylaxis was given per treating physician discretion, starting from the day of PICC insertion. Dalteparin 2500 to 5000 IU or enoxaparine sodium 4000 IU qD were used as low molecular weight heparin (LMWH) prophylaxis. Two-tailed Fisher's test was used for comparison and the P value of less than 0.05 was considered significant. Results: There were 55 males and 40 females with a median age of 62 years (range 21–82 y). Eight patients had T-cell lymphoma, and 88 had B-cell NHL. Nine patients had PICC-related thrombosis (9.5% of all patients). Six patients developed PICC-related thrombosis during the first cycle, one during the second cycle, and two during the third cycle of DA-EPOCH ± R. All events occurred in the group of 68 patients who did not receive antithrombotic prophylaxis/treatment (incidence 13.2%). Antithrombotic prophylaxis was given in 17 (18%) patients: ten patients received low-dose LMWH for prophylaxis for one or two cycles of DA-EPOCH ± R, and seven patients received Aspirin 100 mg for prophylaxis. In additional ten patients, full-dose LMWH was given for deep vein thrombosis at presentation and continued in prophylactic dose. None of the patients that received prophylaxis/treatment developed PICC-related thrombosis (0/27). However, this result did not reach the level of statistical significance (P = 0.056). There was no hemorrhage related to antithrombotic treatment/prophylaxis. Conclusions: The incidence of PICC-related thrombosis in patients without antithrombotic prophylaxis was 13.2%, and two-thirds occurred during the first cycle. In contrast, the patients who received any type of antithrombotic prophylaxis or treatment had no PICC-related thrombosis. Although the level of statistical significance has not been reached (P = 0.056), our results suggest that patients with aggressive lymphoma may benefit from the prophylaxis with low-dose LMWH during the first two cycles of DA-EPOCH ± R. Keywords: DA-R-EPOCH; EPOCH; non-Hodgkin lymphoma (NHL).

Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients.

Peripherally inserted central catheters (PICC) are being increasingly used in critical care setting. However, PICCs are associated with a number of complications, particularly upper extremity venous thrombosis (UEVT), leading to post-thrombotic syndrome, pulmonary embolism and increased risk of catheter-related infection. To review the literature surrounding PICCs and highlight the epidemiology, pathophysiology, diagnosis and management of PICC-related thrombosis in critically ill patients. We performed an electronic literature search of the databases PubMed, EMBASE and Google scholar using set search terms, from their commencement date to the end of January 2014. It has been shown that PICCs may double the risk of deep venous thrombosis compared with centrally inserted venous catheters, in critically ill patients. However, the incidence of PICC-related thrombosis in critically ill patients has not been quantified. Ultrasonography is the preferred diagnostic imaging modality. There are no randomized controlled trials (RCTs) on the best treatment of PICC-related thrombosis in the intensive care unit (ICU) setting and in most cohort studies, anticoagulation strategies with or without PICC removal have been used. Decision to insert a PICC should be taken after careful risk stratification. There is lack of high-quality evidence assessing prevention strategies and management of PICC-related thrombosis in the ICU. Well-designed RCTs are required to estimate the prevalence of UEVT in ICU patients with PICCs and evaluate the efficacy and magnitude of clinical benefit and cost-effectiveness of therapeutic strategies.