PICC-related Venous Thrombosis Research Articles

Risk factors analysis and the establishment of nomogram prediction model for PICC-related venous thrombosis in patients with lymphoma: a double-center cohort-based case-control study.

The objective of this study is to examine the risk factors associated with the occurrence of PICC-Related Venous Thrombosis (PICC-RVTE) in individuals diagnosed with lymphoma, as well as to develop a predictive risk nomogram model. A total of 215 patients with lymphoma treated at Yunnan Provincial Tumor Hospital from January 2017 to December 2020 were retrospectively evaluated as the training cohort; 90 patients with lymphoma treated at the Department of Oncology of the First People's Hospital of Anning, Affiliated to Kunming University of Science and Technology during the January 2021 to September 2023 were evaluated as the validation cohort. Independent influencing factors were analyzed by logistic regression, a nomogram was developed and validated, and the model was evaluated using internal and external data cohorts for validation. A total of 305 lymphoma patients were selected and 35 (11.48%) PICC-RVTE occurred, the median time was 13 days. The incidence within 1-2week was 65.71%. Multivariate analysis suggested that the activity amount, thrombosis history(within the last 12 months), ATIII, Total cholesterol and D-dimer levels were independently associated with PICC-RVTE, and a nomogram was constructed based on the multivariate analysis. ROC analysis indicated good discrimination in the training set (area under the curve [AUC] = 0.907, 95%CI:0.850-0.964) and the testing set (AUC = 0.896, 95%CI: 0.782-1.000) for the PICC-RVTE nomogram. The calibration curves showed good calibration abilities, and the decision curves indicated the clinical usefulness of the prediction nomograms. Patients should be advised to undergo color Doppler ultrasound system testing within two week after the implantation of a PICC catheter to detect PICC-RVTE at an early stage. The validated nomogram can be used to predict the risk of catheter-related thrombosis (CRT) in patients with lymphoma who received at least one chemotherapy after PICC catheterization, no bleeding tendency, no recent history of anticoagulant exposure and no severe heart, lung, renal insufficiency. This model has the potential to assist clinicians in formulating individualized treatment strategies for each patient.

Construction of a nomogram risk prediction model for PICC-related venous thrombosis and its application

ObjectiveTo explore the risk factors of the peripherally inserted central catheter (PICC)-related venous thrombosis and correspondingly construct a nomogram risk prediction model. MethodsThe clinical data of 401 patients receiving PICC catheterization in our hospital from June 2019 to June 2022 were retrospectively analyzed. The independent influencing factors for venous thrombosis were predicted using logistic regression analysis, and significant indicators were screened to construct a nomogram for predicting PICC-related venous thrombosis. The difference in predictive efficacy between simple clinical data and nomogram was analyzed using a receiver operating characteristic (ROC) curve, and the nomogram was internally validated. ResultsSingle-factor analysis showed that catheter tip position, plasma D-dimer concentration, venous compression, malignant tumor, diabetes, history of thrombosis, history of chemotherapy, and history of PICC/CVC catheterization were correlated with PICC-related venous thrombosis. Further multi-factor analysis revealed that catheter tip position, plasma D-dimer elevation, venous compression, history of thrombosis and history of PICC/CVC catheterization were the risk factors for PICC-related venous thrombosis. Based on binary logistic regression analysis, a nomogram prediction model for PICC-related venous thrombosis was constructed. The area under the curve (AUC) was 0.876 (95%CI: 0.818–0.925), with a statistically significant difference (P < 0.01). ConclusionThe independent risk factors for PICC-related venous thrombosis are screened out, including catheter tip position, plasma D-dimer elevation, venous compression, history of thrombosis and history of PICC/CVC catheterization, and a nomogram prediction model with good effect is constructed to predict the risk of PICC-related venous thrombosis.

A Risk Score for Single-Lumen Peripherally Inserted Central Catheter (PICC)-Related Venous Thrombosis in Cancer Patients Undergoing Ambulatory Chemotherapy

Introduction The extended use of peripherally inserted central catheters (PICCs) in cancer patients have simplified the management of the treatment, but also represent an important risk factor of upper limbs thrombosis in a population specially predisposed to thrombotic events. Given the clinical significance of PICC-related venous thrombosis (VT) in cancer patients, a predictive risk model could be helpful. Methods Retrospective unicentric study in which patients with single-lumen PICCs, placed by using ultrasound guidance by a trained nursing team at our centre from January 2015 to May 2019 were included. Inclusion criteria were age ≥18 years-old, histologically confirmed diagnosis of cancer and treatment with ambulatory chemotherapy regimen. The presence of symptomatic PICC-related VT confirmed by ultrasounds, variables regarding PICC (placement, use and removal) and the main clinical and biological characteristics of the patients were recorded. For further analysis, sites of cancer were categorized into "very high risk", those with VT rates of 2-fold or higher than the median risk of the group (lung, testicular, bladder), "high risk", those with rates higher than average (gastric, pancreatic, breast, head and neck), and low risk, those with rates at or below average (colorectal, prostate, lymphoma, gynecologic, and others). The predictive accuracy of the model was assessed: discrimination was evaluated using the c-statistic representing the AUC (area under the receiver-operating characteristic), the Hosmer-Lemeshow test was used to assess model calibration and a bootstrap internal validation procedure with 1000 bootstrap resamples was performed. Results Seventy (6%) of 1170 patients who received PICCs, with a median time of use of 108.5 days [2-525], developed symptomatic, image-confirmed PICC-related VT. Moreover, 10 of the 70 had associated pulmonary embolism. The main characteristics of the patients with and without PICC-VT are summarized in table 1. The median time between PICC placement and thrombosis was 25.5 [1-458] days and VT was more probable on the first 100 days after placement (p=0.002). In univariable analyses, the following variables were significantly associated with the development of symptomatic PICC-VT: primary site of cancer, pre-chemotherapy platelet count ≥350 x109/L and supradiaphragmatic radiotherapy concomitant to PICC use. In addition, PICC tip placement next to the right atrium (in the right atrium or at the lower third of the superior vena cava) is associated with a lower incidence of VT. PICC tip position only could be checked in 447 patients by chest radiography. In the final multivariable logistic regression model (table 2), three variables emerged as risk factors independently associated with PICC-VT: primary site of cancer (very high risk or high risk), pre-chemotherapy platelet count ≥350 x109/L and supradiaphragmatic radiotherapy concomitant to PICC use. PICC tip placement was not considered in the multivariable analysis, since it is a correctable variable. To create the risk score, we assigned points to each of the three variables based on their regression coefficients (table 2). Patients were assigned to one of three risk groups based on cumulative total points: low (score 0), intermediate (score 1), and high (score ≥2). Observed PICC-related VT rates were 3.1% for the low-risk group, 6.4% for the intermediate-risk group and 12.4% for the high-risk group. In a logistic regression model with risk group as a categorical predictor, the risk classification rule was significantly associated with PICC-VT (p <0.001), with odds ratios of 2.136 (95% CI, 1.137-4.011) and 4.456 (95% CI, 2.387-8.320) for intermediate-risk and high-risk groups vs. low-risk group, respectively. C statistic was 0.662 (95%CI 0.598-0.727). Conclusions Primary site of cancer, pre-chemotherapy platelet count and supradiaphragmatic radiotherapy concomitant to the PICC use are independent risk factors for single-lumen PICC-related venous thrombosis in cancer patients undergoing ambulatory chemotherapy. The score proposed herein could be a helpful tool to predict the risk of PICC-related VT. PICC tip placement proximal to the right atrium could reduce the risk of VT. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Functions of Heparin Sodium Injection in the Prevention of Peripherally Inserted Central Catheter-Related Venous Thrombosis in NSCLC Patients during Postoperative Chemotherapy.

Objective This study intended to analyze hazardous factors of venous thrombosis by comparing the effect of different doses of heparin sodium injection on the incidence rate of peripherally inserted central catheter (PICC)-related venous thrombosis in non-small cell lung carcinoma (NSCLC) patients during postoperative chemotherapy. Methods 425 NSCLC patients who received PICC catheterization in Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital from July 2019 to July 2021 were collected. Based on their different pathological types, patients were given two different chemotherapy regimens: pemetrexed+cisplatin or paclitaxel+cisplatin. Patients were grouped according to the different doses of heparin sodium injection adopted. Control group (n = 140). Catheters were sealed with 10 mL saline only. Group I (n = 142). In addition to routine maintenance with normal saline, 2 mL of 10 IU/mL heparin sodium injection was sealed in the catheters under positive pressure every time after catheterization. Group II (n = 143). In addition to routine maintenance with normal saline, 5 mL of 10 IU/mL heparin sodium injection was sealed in the same manner as Group I. The baseline characteristics of the three groups of patients were compared by statistical means. Doppler ultrasonography was applied to check the venous thrombosis. The hazardous factors of venous thrombosis were analyzed through correlation analysis and binary logistic regression method. Results The incidence rates of thrombosis in the control group, Group I, and Group II were 20.00%, 7.04%, and 2.09%, respectively, with statistically significant differences (P < 0.01). Additionally, through the collinear correlation analysis of baseline characteristics, a significant correlation between the dosage of heparin sodium injection and the incidence of thrombosis was observed (P < 0.05), but there were no significant differences between other baseline data and the incidence of thrombosis (P > 0.05). Binary logistic regression analysis revealed that postoperative use of heparin sodium injection (Group I: OR = 0.312; P = 0.003; Group II: OR = 0.082, P < 0.001) was a protective factor for preventing thrombosis. In addition, the thromboprophylaxis effect of Group II was better than that of Group I. No serious adverse reactions were found in safety analysis. Conclusion Heparin sodium could significantly lower the incidence rate of PICC-related venous thrombosis in NSCLC patients during postoperative chemotherapy. Heparin sodium injection is safe enough to be promoted among PICC patients with a high risk of venous thrombosis.

Clinical Characteristics of Venous Thrombosis Associated with Peripherally Inserted Central Venous Catheter in Premature Infants.

Background: This study aimed to analyze clinical characteristics and risk factors for peripherally inserted central catheter (PICC) placement in premature infants. Materials: This study included seven premature infants who were hospitalized in the neonatal intensive care unit (NICU) of Peking University Third Hospital from 1 January 2014–30 June 2021, and suffered PICC-related venous thrombosis. The control group included premature infants (n = 56) matched (1:8) by the following: Did not experience venous thrombosis; born with a similar gestational age (±2 w), birth weight (±200 g); and received PICC catheterization in the same period (±4 w). Clinical neonatal data were collected through the hospital electronic medical record system and analyzed using SPSS version 23. Results: The incidence of PICC-related thrombus was 0.23% (7/3043. Univariate analysis revealed that, compared to the non-thrombotic group, mothers in the thrombosis group had autoimmune diseases (χ2 = 9.844, p = 0.030) and used anticoagulative drugs during pregnancy (χ2 = 8.036, p = 0.025). The corrected gestational age when PICC-related thrombosis occurred in the thrombosis group was 32 + 6 (30 + 1, 34 + 1) weeks. The average time from catheter placement to thrombosis was 5 (1, 12) days. Among infants, 85.7% (6/7) experienced deep vein thrombosis, of which four were in the lower extremity veins; three occurred within 2 days after central venous catheter extubation, and four occurred during central venous catheter indwelling. The clinical manifestations of thrombosis include skin edema, color changes, and skin temperature changes in the affected limbs. The seven neonates had normal coagulation at the time of thrombus diagnosis, but D-dimers significantly increased 1–2 days after thrombosis, returning to normal 5–8 days after thrombus. The thrombus persisted for 4.5 (3, 8) days. All seven neonates were treated with low molecular weight heparin calcium anticoagulation for 10 (3, 17) days and recovered completely. Conclusions: PICC-related thrombosis occurred within 1 week after catheter placement, and thrombosis more likely happened in infants whose mothers had autoimmune disease. When this high-risk factor exists and the patient has been intubated for 1 week and has sudden swelling in the intubated limb, venous ultrasound should be performed immediately to diagnose, and treatment should be provided in a timely manner to reduce adverse events.

Prevention from PICC-related venous thrombosis in the upper limbs of malignant tumor patients with moxibustion combined with plucking at Jiquan (HT 1): a randomized controlled trial

To observe the clinical effect of moxibustion combined with plucking technique at Jiquan (HT 1) for preventing peripherally inserted central catheter (PICC)-related venous thrombosis in the upper limbs of malignant tumor patients. A total of 80 malignant tumor patients undergoing PICC were randomized into an observation group and a control group, 40 cases in each one. In the control group, the routine care for PICC was exerted. In the observation group, besides the routine care, moxibustion combined with plucking technique at Jiquan (HT 1) was added. Mild moxibustion was exerted along the venous distribution of PICC (avoiding the entry site) for 10 to 15 min, and then, the circling moxibustion was applied to Quchi (LI 11), Xuehai (SP 10) and Tianfu (LU 3), 3 to 5 min at each acupoint. Finally, plucking technique was given at Jiquan (HT 1) for 5 to 10 min. This combined therapy was intervened since the 2nd day of PICC placement, once daily, 5 times a week, for 3 weeks totally. The incidence of the PICC-related venous thrombosis in the upper limbs was compared between the two groups on day 42 of placement. On day 2, 7, 14, 21, 28, 35 and 42 of PICC placement, the peak systolic velocity (PSV) and the end-diastolic velocity (EDV) of the subclavicular vein on the placement side were observed separately in the two groups. The incidence of the PICC-related venous thrombosis in the upper limbs in the observation group was lower than that in the control group (2.5% [1/40] vs 17.5% [7/40], P<0.05). From day 7 to 35 of PICC placement, PSV of the subclavicular vein on the placement side was higher than that on the day 2 of PICC placement in the observation group (P<0.05). On day 28 and 42 of PICC placement, PSV of the subclavicular vein on the placement side was lower than that on the day 2 of PICC placement in the control group (P<0.05). In the observation group, EDV of the subclavicular vein on the placement side was higher than that on the day 2 of PICC placement from day 7 to 28 of PICC placement (P<0.05). In the control group, EDV of the subclavicular vein on the placement side from day 28 to 42 of PICC placement was lower than that on the day 2 of PICC placement (P<0.05). From day 7 to 42 of PICC placement, PSV and EDV of the subclavicular vein on the placement side in the observation group were all higher than those in the control group (P<0.01, P<0.05). The combined treatment of moxibustion with plucking technique at Jiquan (HT 1) can effectively prevent PICC-related venous thrombosis in the upper limbs and improve venous blood flow velocity in malignant tumor patients.

Clinical Value of Coagulation Index Changes in Early Diagnosis and Nursing Intervention for PICC-Related Venous Thrombosis in Tumor Patients.

Purpose To explore the clinical value of coagulation index changes in early diagnosis and nursing intervention for PICC-related venous thrombosis in tumor patients. Patients and Methods. A total of 170 tumor patients hospitalized for the first time with catheterization were enrolled from February 2018 to June 2022. According to the diagnostic criteria of venous thromboembolism, high-risk patients with venous thrombosis within 13 days after catheterization were enrolled in the observation group, and those without thromboembolism were enrolled in the control group. Venous blood was taken from all patients on days 1, 5, 9, and 13 after catheterization to measure the change trend of coagulation indexes of patients and to compare the difference of coagulation indexes between the observation group and the control group. Results PT values of all patients were within the normal reference range at days 1, 5, 9, and 13 after catheterization. Compared with the control group, the observation group was significantly reduced on days 5, 9, and 13 after catheterization (P < 0.05), and continued to decrease with the prolonging of time(P < 0.05). After catheterization, the values of all patients at each time point were lower than the normal reference range. Compared with the control group, the values of tumor patients in the observation group were significantly decreased on days 5, 9, and 13 (P < 0.05) and continued to decrease at each time point (P < 0.05). DD values in the observation group were all higher than the normal reference range on days 1, 5, 9, and 13 after catheterization. Compared with the control group, DD values in the observation group were significantly higher on days 1, 5, 9, and 13 after catheterization (P < 0.05). Conclusion PT and APTT continued to decrease after catheterization, and DD kept fluctuating at a high level, highly suggesting the possibility of venous thrombosis. The nursing staff should keep high vigilance and give appropriate nursing intervention.

Risk Factors of PICC-Related Venous Thrombosis in Breast Cancer Patients Undergoing Chemotherapy.

BackgroundTo analyze the risk factors of a peripherally inserted central catheter (PICC)-related venous thrombosis in patients with breast cancer undergoing chemotherapy and explore its preventive measures.MethodsData of 780 patients with breast cancer who underwent PICC chemotherapy in our hospital from January 2014 to June 2015 were retrospectively analyzed. The incidence of catheter-related thrombosis was observed, and related factors of venous thrombosis were analyzed.ResultsAmong the 780 patients with breast cancer, 36 developed PICC-related venous thrombosis. The incidence of which was 4.62% (36/780). The PICC retention time ranged between 60 and 136 days, and the median time was 92 days. Thrombosis was found to occur within seven days after catheterization in three patients (8.33%), between 7 and 30 days in 18 patients (50%), between 31 and 92 days in 12 patients (33.3%), and ≥92 days in three patients (8.33%). Basilic vein puncture-induced thrombosis occurred in 25 patients (3.68%), and median cubital vein and cephalic vein puncture-induced thrombosis occurred in 11 patients (10.78%). The difference was statistically significant (P = 0.001). Thrombosis was not associated with age, punctured limb, platelet count, or chemotherapy drugs (P > 0.05).ConclusionBlood vessel puncture was the main factor that affected PICC-related thrombosis in breast cancer chemotherapy. The basilic vein should be the primary choice for blood vessel puncture. Prolonged catheter retention does not increase the risk of thrombosis.

The Caprini thrombosis risk model predicts the risk of peripherally inserted central catheter-related upper extremity venous thrombosis in patients with cancer

BackgroundA peripherally inserted central catheter (PICC) is often necessary for patients receiving chemotherapy, but there is a risk of PICC-related venous thrombosis (VT). We sought to use the Caprini thrombosis risk model and color Doppler flow imaging for the dynamic monitoring of an eventual thrombosis in patients receiving chemotherapy. MethodsThis prospective study was carried out from January 2018 to May 2019 in patients who underwent PICC implantation and maintenance at the First Affiliated Hospital of Fujian Medical University. The outcome event was the occurrence of PICC-related upper extremity venous thrombosis confirmed by color Doppler flow imaging. ResultsA total of 201 participants were enrolled, of whom 108 (53.7%) developed VT. Three participants (1.5%) developed symptomatic VT. Univariable logistic regression analysis suggested that the Caprini score (odds ratio [OR], 1.243; 95% confidence interval [CI], 1.074-1.438; P = .003), the PICC model (OR, 0.448; 95% CI, 0.223-0.901; P = .024), and a previous history of PICC-related deep vein thrombosis (OR, 9.388; 95% CI, 1.178-74.786; P = .034) were associated with PICC-related upper extremity VT. Multivariable logistic regression analysis showed that only the Caprini score (OR, 1.188; 95% CI, 1.018-1.386; P = .029) was an independent risk factor for PICC-related venous thrombus. A receiver operating characteristic curve analysis showed the Caprini risk assessment model had a predictive value for upper extremity VT, with an area under the curve of 0.615 (95% CI, 0.538-0.693), 74.1% sensitivity, and 44.1% specificity. ConclusionsThe Caprini score is an independent predictor of the development of PICC-related VT in patients with cancer. However, the moderate sensitivity and low specificity of the Caprini risk assessment model may limit its predictive value in the clinical setting.

The Influence of Venous Characteristics on Peripherally Inserted Central Catheter-Related Symptomatic Venous Thrombosis in Cancer Patients.

BackgroundWith increasing use, peripherally inserted central catheters (PICCs) are associated with the risk of venous thrombosis. Few studies have focused on the relationships between venous thrombosis and venous characteristics. This study aimed to identify effects of venous characteristics on symptomatic PICC-related venous thrombosis in cancer patients and explore the relationship between venous characteristics and blood flow velocity.MethodsThe data of patients who underwent placement of PICC were retrospectively studied between January 2015 and September 2017. Symptomatic PICC-related venous thrombosis was confirmed by ultrasound. Univariable, multivariable logistic regression analyses were performed to identify the risk factors associated with PICC-related venous thrombosis. In October 2017, 169 patients with PICCs were enrolled prospectively, and the relationships between blood flow velocity and venous characteristics were recorded and analyzed.ResultsA total of 2933 cancer patients were enrolled in this study; of these patients, 68 experienced symptomatic venous thrombosis. In the bivariate analysis, body mass index (BMI), history of venous thrombosis, triglycerides, tumor category, vessel diameter, vessel depth and arm circumference were associated with thrombosis. The multivariable analyses showed that arm circumference, vascular diameter, triglyceride level and tumor category were independent risk factors for thrombosis. Blood flow velocity was positively correlated with vessel depth and arm circumference but not with vessel diameter.ConclusionDifferent venous characteristics can lead to different blood flow rates, which can affect the incidence of thrombosis. A vein depth of greater than 1.07cm or less than 0.57cm was associated with a higher incidence of PICC-related venous thrombosis, and the greater the arm circumference and vessel diameter, the greater the risk of venous thrombosis.

Prognostic factors for venous thrombosis in patients with peripherally inserted central catheters: Protocol for a systematic review and meta-analysis.

Background:Peripherally inserted central catheters (PICCs) has become increasingly popular in clinical practice because of the ease and safety of insertion and lower cost-effectiveness. The precise incidence and risk of PICC-related venous thrombosis is important to be verified in the context of growing PICC use and an understanding of the risk of venous thrombosis is an important cost and patient safety question.Method:We will search seven electronic databases including the Cochrane Library, MEDLINE, EMBASE, Chinese BioMedical Database, China National Knowledge Infrastructure, Chinese VIP and Wangfang Database regardless of publication date or language. All studies with prognostic factor analysis will be included if they recruited participants with PICC. Primary outcomes will include venous thrombosis. The risk of bias will be assessed by 2 authors using quality in prognostic studies tool. If possible, a meta-analysis in fixed or random effects model will be conducted by R-3.5.1 software, otherwise a narrative synthesis will ensue focusing on prognostic factors. The confidence in cumulative evidence will be assessed by Based on the Grading of Recommendations Assessment, Development and Evaluation.Results:The aim of this study is to retrieve, appraise and summarize the clinical evidence of risk assessment for PICC-related venous thrombosis.Conclusions:This study will assess the precise incidence and risk of venous thrombosis in patients with PICC and provide references for establishing relevant assessment tools.Ethics and dissemination:This study is a protocol for systematic review and meta-analysis of prognostic factors for venous thrombosis in PICC patients. This review will be published in a journal and disseminated in print by peer-review.

The clinical features and related factors of PICC-related upper extremity asymptomatic venous thrombosis in cancer patients: A prospective study.

Peripherally inserted central venous catheter (PICC) is the main venous access for cancer patients when they receive chemotherapy and nutritional support, but PICC-related venous thrombosis has become one of the most common and serious complications. It is very important to further explore the relationship among these features, so that prevent and treat the PICC-related thrombosis.To investigate the clinical features and the related factors of PICC-related upper extremity asymptomatic venous thrombosis in cancer patients, and to provide theoretical basis for the prevention of venous thrombosis.A total of 127 tumor patients with PICC catheterization were selected. Thrombus was detected by color Doppler ultrasound at different times: before catheterization and 24 hours after catheterization, and every week. The study was terminated at the time of thrombosis, and patients who did not develop thrombus were terminated after 6 weeks of follow-up. The clinical characteristics and influencing factors of asymptomatic thrombosis such as vessel diameter, blood flow velocity, thrombosis time, location, and the thrombosis stages were recorded.The incidence of PICC-related upper limbs asymptomatic thrombosis was 48.82% (62/127), and the median time was 3 days. The incidence within 24-hour was 37.1% and within 1 week was 85.49%. A total of 81 venous thrombosis were found in 62 patients with asymptomatic thrombosis, there were 19 (23.5%) venous thrombosis in the deep veins while 62 (76.5%) in the superficial veins. Furthermore, thrombosis stages can be divided into 3 levels: stage I accounted for 51.85% (42/81), stage II accounted for 37.04% (30/81), and stage III accounted for 11.11% (9/81). The group trajectory analysis indicated the 3 changes of blood flow velocity during the follow-up period: downward trend, upward trend, and steady fluctuations. Survival analysis indicated that the cohort with downward trend have the high risk of thrombosis (67.90% vs 19.00% vs 45.10%). Cox proportional hazards model suggested that the patient's Eastern Cooperative Oncology Group score (hazard ratio [HR] 2.791, 95% confidence interval [CI] 0.08–0.76) and blood flow velocity (HR 0.250, 95% CI 2.01–3.87) was the risk of PICC-related asymptomatic thrombosis.PICC catheterization can affect blood flow and asymptomatic thrombosis can occur at an early stage. Patient's upper limb activities should be guided to promoting blood circulation, thus effectively preventing thrombosis. Asymptomatic thrombosis can also be detected by color Doppler ultrasound system, within a recommended time of 1 week after catheterization.

Risk factors associated with peripherally inserted central catheter-related venous thrombosis in hospitalized patients of advanced age.

ObjectiveThis study was performed to determine the risk factors associated with peripherally inserted central catheter (PICC)-related venous thrombosis in patients of advanced age (>65 years).MethodsIn total, 549 hospitalized patients aged 66 to 104 years who were undergoing PICC placement from January 2008 to December 2014 were enrolled. Symptomatic venous thrombosis was confirmed by B-mode or Doppler ultrasonography in the presence of clinical signs. Logistic regression analysis was performed on the variables of interest to identify the risk factors for thrombosis. Odds ratios (ORs) with the corresponding 95% confidence intervals were generated.ResultsOf the 549 patients with PICC placement, 106 (19.3%) developed PICC-associated venous thrombosis, 84 cases of which were symptomatic. The logistic regression results revealed that PICC-related venous thrombosis was associated with a history of venous thrombosis (OR, 6.745 [3.237–14.056]), number of lumens (OR, 1.934 [1.362–2.572] and OR, 3.762 [1.672–5.932] for dual and triple lumens, respectively), and PICC gauge (OR, 1.821 [1.256–2.537] and OR, 3.864 [1.367–8.251] for 5-Fr and 6-Fr, respectively).ConclusionsA history of thrombosis, high number of lumens, and large-gauge catheters were strong risk factors for patients aged >65 years undergoing PICC placement.

Symptomatic venous thromboembolism associated with peripherally inserted central catheters predicts a worse survival in nasopharyngeal carcinoma: results of a large cohort, propensity score\u2013matched analysis

BackgroundDespite increasing use, symptomatic venous thromboembolism (VTE) associated with peripherally inserted central catheter (PICC) is a common complication in nonmetastatic nasopharyngeal carcinoma (NPC) patients.MethodsA total of 3012 nonmetastatic NPC patients were enrolled in this retrospective study, and we applied Cox regression and log-rank tests to assess the association between PICC-VTE and survival using the propensity score method (PSM) to adjust for gender, age, radiotherapy technique, tumor stage, node stage, UICC clinical stage and pre-treatment EBV DNA.Results217 patients developed PICC-VTE, with an incidence of 7.20%. PSM identified 213 patients in the cohort with VTE and 852 in that without. Patients who developed PICC-VTE had a shorter 5-year PFS (77.5% vs 87.6%, p < 0.001), DMFS (85.0% vs 91.2%, p < 0.001), LRRFS (93.9% vs 97.7%, p < 0.001) and OS (85.4% vs 87.6%, p < 0.001). Subgroup analyses indicated that no significant survival difference was found between PICC-related superficial venous thrombosis and deep vein thrombosis, nor did different anticoagulant treatment methods.ConclusionsPICC-VTE was associated with a worse survival outcome in nonmetastatic NPC patients. A prospective randomized clinical trial is required to verify the results.

Incidence and Risk Factors of Peripherally Inserted Central Catheter-related Venous Thrombosis in Lung Cancer Patients

Background: Peripherally inserted central catheter (PICC) is widely used in patients with cancer. PICC-related venous thrombosis is one of the most severe complications, but the risk factors are not well defined. We analyzed the incidence and risk factors causing PICC-related venous thrombosis in patients with lung cancer. Methods: A retrospective study was conducted in Guizhou Provincial People's hospital from January 2012 to December 2015. All lung cancer patients who met inclusion criteria were included. The influences of sex, age, limb, puncture vein, platelet count, prothrombin time (PT), and fibrinogen (FIB) on the incidence of venous thrombosis were analyzed. Univariable analysis was performed using χ2 detection, and multivariate analysis was carried out using Logistic regression analysis. Results: In total, 1972 patients with 49 cases of PICC-related venous thrombosis were enrolled. The average time interval from PICC placement to thrombosis forming was 15.77 ± 7.62 days. Univariable analysis showed that gender, indwelling limb, indwelling vein, and FIB value had significant influence on the incidence of PICC-related venous thrombosis (P < 0.05). Furthermore, logistic regression model analysis revealed that gender (P = 0.027, 95% CI = 1.320-4.275), indwelling vein (P = 0.012, 95% CI = 1.331-3.046), and FIB value (P = 0.031, 95% CI = 1.605-3.663) were associated with the incidence of PICC-related venous thrombosis. Conclusion: Gender, indwelling vein, and FIB are risk factors for PICC-related venous thrombosis.

The high-risk factors and nursing of venous thrombosis caused by PICC catheter-related on patients with acute pancreatitis

Objective To explore the high-risk factors of upper extremity venous thrombosis caused by PICC catheter on patients with acute pancreatitis, and sum up the nursing countermeasures. Methods A total of 368 cases of patients with acute pancreatitis gastroenterology indwelling PICC catheter from February 2015 to January 2016 in our hospital were selected.13 cases of patients with PICC-related venous thrombosis were studied retrospectively to analyze the age, gender, intravenous catheter, catheter body, disease severity, D-dimer (D-D), prothrombin time (PT), fibrinogen (FIB) value, and the relationship between APTT and the formation of thromboplastin venous thrombosis and the time for the formation of thrombosis. Results 13 patients were diagnosed as venous thrombosis, the differences of gender and age were not statistically significant(P>0.05). There was statistical significance in terms of the difference of thrombosis of mild and relatively severe pancreatitis patients(P<0.01). The highest rate of the formation of vein thrombosis was right cephalic (37.5%). The incidence of vein thrombosis caused by the left and right upper extremity median cubital was 12.0% and 4.7% respectively.The incidence of vein thrombosis caused by left right basilic vein thrombosis rates was 1.3% and 0.6% respectively.The PT of the patients with vein thrombosis was higher than that of the patients without vein thrombosis, and the difference was statistically significant(P<0.05). APTT, FIB , D-D of patients with thrombosis was significantly higher than that of the patients without vein thrombosis, and the difference was significant(P<0.01). The average time of the formation of thrombosis after indwelling PICC catheter was(12.6±7.8) days, thrombosis can occur as early as 3 to 4 days after the first catheter. Conclusions The formation of the venous thrombosis is directly affected by the blood coagulation and the changes of the fibrinolysis system of the patients with severe acute pancreatitis.Nurses should strengthen the awareness of prevention for PICC catheter-related venous thrombosis.The patients' coagulation indicator is strictly assessed of before the catheter.The appropriate intravenous catheter is selected during the catheter.The comprehensive nursing intervention is conducted after the catheter to reduce the incidence of PICC catheter-related venous thrombosis and prolong the catheterization time. Key words: Acute pancreatitis; PICC catheter; Venous thrombosis; Nursing Strategy

Analysis of risk factors and the establishment of a risk model for peripherally inserted central catheter thrombosis

Abstract Objective To investigate the main risk factors of peripherally inserted central catheter (PICC) related upper extremity deep venous thrombosis and establish the risk predictive model of PICC-related upper extremity deep venous thrombosis. Methods Patients with PICC who were hospitalized between January 2014 and July 2015 were studied retrospectively; they were divided into a thrombosis group (n = 52), with patients who had a venous thrombosis complication after PICC, and a no-thrombosis group (n = 144), with patients without venous thrombosis. To compare between the two groups, significantly different variables were selected to perform multivariate logistic regression to establish the risk-predictive model. Results The PICC catheter history, catheter tip position, and diameter of blood vessel were the key factors for thrombosis. The logistic regression predictive model was as follows: Y = 3.338 + 2.040 × PICC catheter history +1.964× catheter tip position −1.572× diameter of vessel. The area under the receiver operating characteristic curve for the model was 0.872, 95%CI (0.817–0.927). The cut-off point was 0.801, the sensitivity of the model was 0.832, and the specificity was 0.745. Conclusions The PICC catheterization history, catheter tip position, the diameter of blood vessel were the key factors for thrombosis. The logistic regression risk model based on these factors is reliable for predicting PICC-related upper extremity deep venous thrombosis.

The complete recanalization of PICC-related venous thrombosis in cancer patients: A series of case reports

In this study, cancer patients with venous thrombosis associated with the use of peripherally inserted central catheters (PICCs) underwent complete recanalization by the administration of Panax notoginseng saponins (PNS), which vary from heparin or urokinase in that they do not have the same risks associated with thrombolysis, including bleeding. To the best of our knowledge, this is the first study concerning the treatment of cancers with PNS to be reported in the literature. Three cancer patients aged 30–50 years old, two females and one male, were subjected to chemotherapy. On the first day of chemotherapy, a PICC was inserted into the right basilic vein with its tip in the superior vena cava. On the third day of chemotherapy, pain, swelling and skin flushing started. In the following days, particularly days 10–13, a Doppler ultrasound examination confirmed a long thrombus along the PICC line in the axillary vein and brachial veins in each patient. The patients rejected the insertion of an inferior vena cava filter, and neither heparin nor urokinase were administered due to contra-indications. An injection of PNS (200 mg) was administered every day. On days 20–28 of chemotherapy, the thrombus in the axillary and brachial veins disappeared in the three patients. It was concluded that PNS promote blood circulation, which prevents blood stasis and reduces the toxicity of cisplatin. The results suggest that PNS are a feasible and effective treatment option for many types of cancer, but have a broader clinical impact on cancer patients with PICC-related venous thrombosis. Therefore, this study is an original case report of particular interest to cancer patients with PICC-related venous thrombosis.

The Incidence of Symptomatic, PICC-Related Venous Thrombosis in Hospitalized Patients with Inflammatory Bowel Disease

The Incidence of Symptomatic, PICC-Related Venous Thrombosis in Hospitalized Patients with Inflammatory Bowel Disease