Risk Of Catheter-related Thrombosis Research Articles

Construction and validation of a nomogram prediction model for the catheter-related thrombosis risk of central venous access devices in patients with cancer: a prospective machine learning study.

Central venous access devices (CVADs) are integral to cancer treatment. However, catheter-related thrombosis (CRT) poses a considerable risk to patient safety. It interrupts treatment; delays therapy; prolongs hospitalisation; and increases the physical, psychological and financial burden of patients. Our study aims to construct and validate a predictive model for CRT risk in patients with cancer. It offers the possibility to identify independent risk factors for CRT and prevent CRT in patients with cancer. We prospectively followed patients with cancer and CVAD at Xiangya Hospital of Central South University from January 2021 to December 2022 until catheter removal. Patients with CRT who met the criteria were taken as the case group. Two patients with cancer but without CRT diagnosed in the same month that a patient with cancer and CRT was diagnosed were selected by using a random number table to form a control group. Data from patients with CVAD placement in Qinghai University Affiliated Hospital and Hainan Provincial People's Hospital (January 2023 to June 2023) were used for the external validation of the optimal model. The incidence rate of CRT in patients with cancer was 5.02% (539/10 736). Amongst different malignant tumour types, head and neck (9.66%), haematological (6.97%) and respiratory (6.58%) tumours had the highest risks. Amongst catheter types, haemodialysis (13.91%), central venous (8.39%) and peripherally inserted central (4.68%) catheters were associated with the highest risks. A total of 500 patients with CRT and 1000 without CRT participated in model construction and were randomly assigned to the training (n = 1050) or testing (n = 450) groups. We identified 11 independent risk factors, including age, catheterisation method, catheter valve, catheter material, infection, insertion history, D-dimer concentration, operation history, anaemia, diabetes and targeted drugs. The logistic regression model had the best discriminative ability amongst the three models. It had an area under the curve (AUC) of 0.868 (0.846-0.890) for the training group. The external validation AUC was 0.708 (0.618-0.797). The calibration curve of the nomogram model was consistent with the ideal curve. Moreover, the Hosmer-Lemeshow test showed a good fit (P > 0.05) and high net benefit value for the clinical decision curve. The nomogram model constructed in this study can predict the risk of CRT in patients with cancer. It can help in the early identification and screening of patients at high risk of cancer CRT.

Central venous catheter-related thrombosis in patients with amyotrophic lateral sclerosis.

Central venous catheterization may be required in patients with amyotrophic lateral sclerosis (ALS) for parenteral nutrition, antibiotic treatment, or blood sampling. Different venous access devices can be taken into consideration-centrally inserted central catheters (CICC), peripherally inserted central catheters (PICC), and femorally inserted central catheters (FICCs)-depending on the clinical conditions of the patients. Regardless of the type of access, the presence of paraplegia or tetraplegia is commonly considered a risk factor for catheter-related thrombosis (CRT). This retrospective study analyzes the rate of CRT and other non-infectious complications associated with central venous access in a cohort of 115 patients with paraplegia or tetraplegia, most of them affected by ALS (n = 109). In a period of 34 months, from January 2021 to October 2023, we inserted 75 FICCs, 29 CICCs, and 11 PICCs. PICCs were inserted only in patients with preserved motility of the upper limbs. All devices were inserted by trained operators adopting appropriate insertion bundles. We had no immediate or early complication. Though antithrombotic prophylaxis was adopted only in 61.7% of patients, we had no symptomatic CRT. Other non-infectious complications were infrequent (4 out of 115 patients). These results suggest (a) that the presence of paraplegia or tetraplegia is not necessarily associated with an increased risk of CRT, (b) that the adoption of well-designed insertion bundles plays a key role in minimizing non-infectious complications, and (c) that the insertion of FICCs by direct cannulation of the superficial femoral vein at mid-thigh in paraplegic/tetraplegic patients may have the same advantages which have been described in the general population.

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.

Incidence and clinical progression of asymptomatic peripherally inserted central catheter–related thrombosis in solid neoplasm patients: ultrasound insights from a prospective cohort study

BackgroundManaging central venous catheters in patients with neoplasms is challenging, and peripherally inserted central catheter PORT (PICC-PORT) has emerged as a promising option for safety and efficacy. However, understanding the clinical progression of catheter-related thrombosis (CRT) in cancer patients with central venous catheters remains limited, especially in certain neoplasm types associated with a higher risk of venous thrombosis. ObjectivesThis study aims to assess the effectiveness of ultrasound-guided management in detecting and treating asymptomatic CRT in cancer patients with PICC. MethodsIn this prospective cohort study of 120 patients with solid neoplasms receiving chemotherapy, we investigated the incidence of isolated upper-extremity superficial vein thrombosis, upper-extremity deep vein thrombosis, and fibrin sheath formation through ultrasound follow-up at 30 and 90 days after catheter insertion. We analyzed risk factors associated with CRT and compared incidence rates between PICC-PORT and traditional PICC. ResultsAmong the cohort, 69 patients (57.5%) had high-risk thromboembolic neoplasm, and 31 cases (25.8%) of CRT were observed, mostly within 30 days, with only 7 cases (22.6%) showing symptoms. Traditional PICC use (odds ratio, 5.86; 95% CI, 1.14-30) and high-risk thromboembolic neoplasm (odds ratio, 4.46; 95% CI, 1.26-15.81) were identified as independent risk factors for CRT. ConclusionThe majority of CRT present asymptomatically within the first 30 days of venous catheter insertion in patients with solid neoplasms. Ultrasound follow-up is valuable for detecting asymptomatic CRT. The risk of CRT was lower with PICC-PORT than with PICC. Additionally, the risk of CRT was found to be higher in patients with high-risk thromboembolic neoplasms. It is crucial for larger studies to confirm the utility of treating asymptomatic thromboses and isolated superficial thrombosis.

Patient preferences and willingness to pay for central venous access devices in breast cancer: A multicenter discrete choice experiment

BackgroundDespite being a significant management decision in clinical or nursing practice, there is limited understanding of the preferences regarding risks, benefits, costs, and other attributes of patients with breast cancer when selecting peripherally inserted central catheters or totally implanted ports. The objective of this study is to investigate the preferences of patients with breast cancer who require chemotherapy when selecting an optimal central venous access device. MethodsData on patients' preferences for central venous access devices were collected using a face-to-face discrete choice experiment from the oncology departments of three public hospitals in China representing the eastern (Zhejiang province), central (Henan province), and western (Sichuan province) regions. The study used six attributes to describe the preferences of breast cancer patients for central venous access devices, including out-of-pocket cost, limitations in activities of daily living, catheter maintenance frequency, risk of catheter-related thrombosis, risk of catheter-related infection, and size of incision. Data were analyzed using a conditional logit model and mixed logit model. The marginal willingness to pay (mWTP) was calculated by assessing the ratio of the preference for other attributes to the preference for out-of-pocket cost. ResultsA total of 573 respondents completed the survey. The discrete choice experiment results showed that respondents strongly preferred a central venous access device with a catheter maintenance frequency of one time a month (vs four times a month, β = 1.188, p < 0.001), the lower risk of catheter-related thrombosis (2 % vs 10 %, β = 1.068; p < 0.001) and lower risk of catheter-related infection (2 % vs 8 % risk: β = 0.824; p < 0.001). Respondents were willing to pay CNY ¥11,968.1 (US$1776.5) for a central venous access device with a catheter maintenance frequency of one time a month rather than four times a month, ¥10,753.6 (US$1596.2) for a central venous access device with 2 % thrombosis risk over one with 10 %, and ¥8302.0 (US$1232.3) for a central venous access device with 2 % infection risk over one with 8 %. Respondents with longer travel time to the hospital, younger than 50 years old, and with urban employee basic medical insurance were willing to pay more for an improvement in the attributes. ConclusionsThese findings suggest that patients with breast cancer were mainly concerned with the out-of-pocket cost, catheter maintenance frequency, risk of catheter-related thrombosis and risk of catheter-related infection when choosing a central venous access device for the delivery of chemotherapy. In clinical or nursing practice, when making central venous access device recommendation for young patients and those who live far from hospitals, totally implanted ports may be a preferable choice.

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.

Development and validation of a prediction model of catheter-related thrombosis in patients with cancer undergoing chemotherapy based on ultrasonography results and clinical information

Central venous catheters can be used conveniently to deliver medications and improve comfort in patients with cancer. However, they can cause major complications. The current study aimed to develop and validate an individualized nomogram for early prediction of the risk of catheter-related thrombosis (CRT) in patients with cancer receiving chemotherapy. In total, 647 patients were included in the analysis. They were randomly assigned to the training (n = 431) and validation (n = 216) cohorts. A nomogram for predicting the risk of CRT in the training cohort was developed based on logistic regression analysis results. The accuracy and discriminatory ability of the model were determined using area under the receiver operating characteristic curve (AUROC) values and calibration plots. Multivariate logistic regression analysis showed that body mass index, risk of cancer-related thrombosis, d-dimer level, and blood flow velocity were independent risk factors of CRT. The calibration plot showed an acceptable agreement between the predicted and actual probabilities of CRT. The AUROC values of the nomogram were 0.757 (95% confidence interval: 0.717–0.809) and 0.761 (95% confidence interval: 0.701–0.821) for the training and validation cohorts, respectively. Our model presents a novel, user-friendly tool for predicting the risk of CRT in patients with cancer receiving chemotherapy. Moreover, it can contribute to clinical decision-making.

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.

Catheter-Related Thrombosis Incidence and Risk Factors in Adult Cancer Patients with Central Venous Access Devices

▪Central venous access devices (CVADs) are commonly employed in the management of cancer patients, facilitating administration of chemotherapy, parenteral nutrition, blood products and antibiotics, and stem cell collection/reinfusion. Previous studies have demonstrated certain cancer subtypes to have a higher risk of thrombosis, when incorporated into a risk scoring system. We sought to review the incidence and risk factors for catheter related thrombosis (CRT) in a large cohort of hematology and oncology patients using a retrospective study in an Australian tertiary hospital, including the influence of cancer subtype.We reviewed data from a prospectively gathered CVAD database. The presence of CRT was defined as a positive duplex ultrasound scan either while line was in situ or within one week of line removal. Only patients symptomatic for CRT underwent USS imaging. We performed univariate and multivariate cox regression, and competing risk analysis to assess which parameters were associated with an increased risk of CRT.5043 central lines were inserted into 3218 patients between Jan 2003 and Dec 2016 with the majority (72%) of lines being peripherally inserted central catheters (PICCs). Overall incidence of CRT was 3.55%, at a rate of 0.45 per 1000 line days. CRT developed at a median of 12 days following line insertion. In univariate analysis, PICCs were associated with the highest rates of CRT (HR 7.48, 95%CI 1.03-54.1, p=0.046) when compared to non-tunnelled lines, while implantable ports (HR 0.47 95%CI 0.03-7.90 p=0.597) and tunnelled catheters (HR 0.00) were not associated with increased thrombosis risk. Patient age <50 (HR 1.46, 95% CI 1.06-2.00, p=0.019) and number of prior CRT (HR 1.95, 95% CI 1.30-2.92, p=0.01) were associated with higher thrombosis rates in univariate analysis. In multivariate analysis, PICC lines (HR 8.63, 95% CI: 1.17-63.5 p=0.034) and number of prior CRT (HR 1.84, 95% CI 1.18-2.86, P=0.007) increased CRT risk. Age groups 50-61 (HR 0.56 95% CI 0.37-0.83 p=0.004) and > 61 (HR 0.65 95% CI 0.46-0.91 p=0.012) were associated with reduced risk compared to age group <50. We used the tumor score from the previously validated Khorana score and found mixed results, with intermediate, but not high-risk tumours associated with higher thrombosis risk (HR1.42 95%CI 1.03-1.95 p=0.031 and HR 0.65 95% CI 0.26-1.60 p=0,346 respectively). When individual cancer subtypes were analysed in univariate analysis, Hodgkin lymphoma (HR 2.43 95% CI 1.01-5.82 p=0.046) and germ cell tumours (HR 2.63 95% CI 1.05-6.55 p=0.038) were found to be associated with increased CRT rates. However, once controlling for age and line type in multivariate analysis, no subgroup of cancer was associated with higher CRT rates. Side of insertion was not associated with higher thrombosis risk (left vs right HR 0.79 95% CI 0.58-1.07 P=0.13). When the analysis was restricted to PICC lines (n=3642), we found no difference in significant predictors of CRT.In conclusion, this is the largest published series reviewing CRT from a single centre. In patients with cancer, age <50, presence of a PICC line and prior CRT were associated with higher risk of CRT. Cancer subtype and insertion side were not significant predictors of thrombosis in this series. DisclosuresNo relevant conflicts of interest to declare.

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.

Should PICCs be avoided in patients with certain solid organ cancers?

6572 Background: Peripherally inserted central catheters (PICCs) are widely utilized in oncology. Previous studies have shown a high risk of catheter-related thrombosis and bloodstream infection in the uniquely susceptible oncologic population; however, most studies are limited by single center, outpatient, retrospective designs. Therefore, we performed a multi-center study to further describe PICC use and complications in the solid tumor population within the inpatient setting. Methods: Data was collected on PICC lines inserted across 50 hospitals in Michigan from November 2013 to December 2019. Patients with a solid tumor diagnosis at time of PICC insertion were selected (n = 3,956). Indications for PICC placement, catheter characteristics, and associated complications were compared by metastatic (n = 1,488) and non-metastatic (n = 2,468) disease. Complications were also compared by cancer type. Major complications were defined as central line associated blood stream infection (CLABSI), catheter occlusion, deep vein thrombosis (DVT), and pulmonary embolism (PE). Paired t-test and Pearson Chi-square test were used for analyses. Results: PICCs were most commonly placed for antibiotics (n = 1232, 31%) and chemotherapy (n = 907, 23%). The majority of catheters were multi-lumen with 61% (n = 2362) double lumen and 8% (n = 326) triple lumen. Median dwell time was 13 days. Notably, 17% of patients had another central venous catheter (CVC) at time of placement. Metastatic patients were more likely to have a PICC placed for difficult venous access (24.7% vs 17.7%, p &lt; 0.001) and total parenteral nutrition (20.2% vs 12.3%, p &lt; 0.001) as well as to have a current CVC in place (22% vs 14%, p &lt;.001). Non-metastatic patients were more likely to have a PICC placed for chemotherapy (24.1% vs 20.9%, p = 0.02) and have a longer median dwell time (13.0d vs 11.0d, p = 0.04). Of all solid tumor patients, 15.5% (n = 612) experienced a major complication. Catheter occlusion occurred most frequently (n = 402, 10.2%) followed by DVT (n = 138, 3.5%), CLABSI (n = 107, 2.7%), and PE (n = 22, 0.6%). Catheter occlusion was more likely to occur in non-metastatic patients (11% vs 8.8%, p = 0.03). Rates of CLABSI, DVT, and PE did not differ significantly by presence of metastases. Certain cancers had a higher frequency of major complications when compared to the average solid tumor cohort rate of 15.5%; these were malignant brain (17.2%), pancreatic (18.4%), uterine (18.5%), and ovarian tumors (24.2%). Conclusions: PICCs are associated with significant complications in 16% of patients with solid organ cancers. Alternate access such as an implanted port should be considered; alternatively, limiting PICC placement in the presence of concurrent CVC or minimizing use of multiple lumen PICCs may limit complications and resultant morbidity. Specifically, these considerations may apply preferentially to patients with certain solid organ cancers with higher rates of PICC associated morbidity.

Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy

Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.

Catheter related thrombosis in hospitalized infants: A neural network approach to predict risk factors

IntroductionWe sought to investigate the predictors of catheter-related thrombosis (CRT) in a cohort of critically ill hospitalized infants and using a novel approach (the artificial neural network - ANN) in combination with conventional statistics to identify/confirm those predictors. MethodsWe performed a retrospective analysis of all infants with a central or peripherally inserted central venous catheter (CVC/PICC) between 2015 and 2018. ANN was generated to investigate the predictors of CRT. The predictive variables examined in the ANN were age, gender, weight, co-morbid conditions, line type, use of ultrasound (USG), emergent line placement, location of line tip, any major surgical procedures, use of mechanical ventilation, exposure to cardio-pulmonary bypass (CPB), past-history of CVC/PICC, or thrombosis. Binary logistic regression was performed to calculate odds ratios (ORs) and determine which factors were significant in predicting CRT. ResultsOf total of 613 infants, 59.9% of patients had a history of previous CVC or PICC and 12.2% had a history of thrombus as documented by USG in the past three months. CPB exposure was present in 48.1%. The incidence of CRT was 10.7%. Independent predictors of CRT were the line tip in IVC (OR: 2.37, 1.08–5.21, P = 0.032), history of thrombosis (OR: 2.40, 1.16–4.96, P = 0.019), previous CVC/PICC (OR: 2.80, 1.24–6.33, P = 0.014) and exposure to CPB (OR: 2.749, 1.08–6.98, P = 0.034). A sensitivity analysis was performed to determine the normalized importance of each variable used to create the ANN. The most important variables were age (with normalized importance of 100%), history of thrombosis, weight, and exposure to CPB (normalized importance of 68.2%). ConclusionsNearly 1 in 10 infants developed CRT. We found that catheter tip in IVC, exposure to CPB, history of vein thrombosis and history of CVC/PICC placement in the past 3 months are independently associated with a higher risk of CRT in infants by using conventional and neural network methods.

Factors Associated with Catheter-Related Thrombosis in Autologous Stem Cell Transplant Patients: Can We Predict Risk?

Central venous catheters (CVCs) are central to the process of autologous hematopoietic stem cell transplantation (AHCT) for hematologic malignancies. Large bore (14F to 15F) CVCs are routinely used for stem cell collection, administration of medications and blood products, and total parental nutrition. Up to 20% of patients experience catheter-related thrombosis (CRT), a major complication typically requiring at least 3 months of anticoagulation. This can lead to bleeding, further complicating the post-transplant course. Factors associated with CRT include endothelial damage due to conditioning regimens, bacteremia, and immobilizations. Furthermore, in ambulatory patients with cancer, increased risk of venous thromboembolism has been seen in patients with low hemoglobin (&amp;lt;10 g/dL), elevated pre-chemotherapy leukocyte count (&amp;gt;11 x 109/L), elevated pre-chemotherapy platelet count (&amp;gt;350 x 109/L), those receiving erythropoiesis-stimulating agents, and obesity (body mass index &amp;gt; 35 kg/m2). We hypothesized that these factors may also confer CRT risk in those undergoing AHCT. To test this hypothesis and to further refine our understanding of the risks of CRT in this population, we compare characteristics of patients with CRT to those without in this retrospective, case-control study. Using prospectively collected data from the University of Minnesota Blood and Marrow Transplantation Database, we studied 1049 consecutive adults (age &amp;gt; 18 years) with lymphoma or multiple myeloma who underwent AHCT between 2006 and 2019. Available medical records were manually curated for the occurrence of CRT. We identified 92 subjects with CRT events, which were defined as mural thrombus with partial or total occlusion of a vessel, pulmonary embolism, or right atrial thrombus in which a catheter was present or had been present within the prior 30 days. CRT diagnosis was made by imaging, which was performed for either symptoms or signs of venous thrombosis, or for routine disease surveillance. We then identified 184 controls who were matched for age, sex, disease, and transplant date. We excluded from our control group those who received prophylactic anticoagulation in the peri-transplant period. In a univariate analysis, we observed an increased risk in CRT in those patients with history of VTE (OR 32.00, 95% CI: 4.24-241.30), mucositis in the peri-transplant period (OR 1.65, 95% CI: 1.00-2.73), hemoglobin increased above the median of 10.3 g/dL (OR 1.48, 95% CI: 1.26-1.73), those with indwelling port in addition to CVC (OR 1.76, 95% CI: 1.02-3.05), and those with body mass index (BMI) &amp;gt; 35 kg/m2 (OR 2.44, 95% CI: 1.12-5.34). Multivariate conditional logistic regression analysis upheld the impact of BMI &amp;gt; 35 kg/m2 (OR 2.53, 95% CI: 1.05-6.13). CRT is a major contributor to morbidity in the AHCT setting. Mucositis, presence of a port, and history of VTE have previously been associated with CRT events. Our study elucidates additional risk factors that may contribute to CRT risk, including obesity and higher than average hemoglobin concentration in comparison to the controls. Further study in larger cohorts is warranted to clarify the magnitude of risk of these factors in the adult AHCT population. Figure Disclosures Bachanova: BMS: Research Funding; Incyte: Research Funding; Gamida Cell: Membership on an entity's Board of Directors or advisory committees, Research Funding; Karyopharma: Membership on an entity's Board of Directors or advisory committees; FATE: Research Funding; Kite: Membership on an entity's Board of Directors or advisory committees. Shah:Aspen Pharma: Research Funding.

Peripherally Inserted Central Catheter (PICC) Related Deep Venous Thrombosis: A Retrospective Cohort Study on Incidence and Risk Factors in a Single Center

INTRODUCTION: The use of Peripherally Inserted Central Catheters (PICCs) has increased significantly in the last years due to their advantages compared to the other types of central catheters: easier and protocolized insertion by specialized nurse-led teams; cost-effectiveness; ease of management, ... However, an increase in the incidence of Catheter Related Thrombosis (CRT) has been observed with this type of device, especially in cancer patients and in the critical care setting. The main objective of this study is to determine the incidence of PICC related deep venous thrombosis in oncologic and onco-hematologic patients at the Donostia University Hospital, in Spain. The secondary outcome is the identification of possible risk factors associated with this event. METHODS: Using the database created and handled by the nurse-led Intravenous Therapy Team (ITT) in our center, in which all inserted PICCs are prospectively and consecutively included since 2011, a retrospective analysis was conducted on oncology and hemato-oncology-derived adult patients (over 18 years old) with a PICC inserted between May 15th 2018 and December 15th 2019. In the total population, several characteristics of the patient, of the PICC and of the thrombotic event were descriptively analyzed, and a bivariant analysis of four potential risk factors was carried out using Pearson's Chi-squared test. Patient and CRT treatment-associated risk factors were more exhaustively analyzed in the subgroup of patients with CRT. The missing data were obtained from the electronic clinical history records. RESULTS: The final study sample consisted of 1024 PICCs (n=1024), 19,10% (n=313) derived from the Hematology department and 43,62% (n=715) from the Oncology department (tables 1 and 2). The global incidence of CRT was 4,9% (n=50): 5.8% in hematologic patients and 4.5% in patients derived from Oncology. In the bivariant analysis no significant association was found between the selected potential risk factors (department of origin, PICC lumen number, PICC material and the catheter-to-vessel ratio) and CRT (table 3). In terms of the treatment administered to patients presenting CRT, in 80% of the cases (n=40) a Low Molecular Weight Heparin (LMWH) at therapeutic dose was initiated; in 10% (n=5) LMWH at a lower dose, and in 2 patients treatment could not be initiated because of thrombopenia. Finally, the PICC was withdrawn in only 8 patients after the diagnosis of the thrombotic event. CONCLUSIONS: The majority of the studies on PICC associated venous thrombosis in cancer patients are small, observational, retrospective, and without comparison groups. Here we present a work with an important sample size, a homogeneous population and with a prospective data collection. The CRT incidence has been similar to that described in the literature and significant association has not been found between the included potential risk factors and CRT. In conclusion, this study reflects the need of more trials on this subject, in particular to identify CRT risk factors in order to design effective prevention strategies. Disclosures No relevant conflicts of interest to declare.

Development and Validation of a New Clinical Prediction Model of Catheter-Related Thrombosis Based on Vascular Ultrasound Diagnosis in Cancer Patients.

Background: Central venous catheters are convenient for drug delivery and improved comfort for cancer patients, but they also cause serious complications. The most common complication is catheter-related thrombosis (CRT).Objectives: This study aimed to evaluate the incidence and risk factors for CRT in cancer patients and develop an effective prediction model for CRT in cancer patients.Methods: The development of our prediction model was based on a retrospective cohort (n = 3,131) from the National Cancer Center. Our prediction model was confirmed in a prospective cohort from the National Cancer Center (n = 685) and a retrospective cohort from the Hunan Cancer Hospital (n = 61). The predictive accuracy and discriminative ability were determined by receiver operating characteristic (ROC) curves and calibration plots.Results: Multivariate analysis demonstrated that sex, cancer type, catheter type, position of the catheter tip, chemotherapy status, and antiplatelet/anticoagulation status at baseline were independent risk factors for CRT. The area under the ROC curve of our prediction model was 0.741 (CI: 0.715–0.766) in the primary cohort and 0.754 (CI: 0.704–0.803) and 0.658 (CI: 0.470–0.845) in validation cohorts 1 and 2, respectively. The model also showed good calibration and clinical impact in the primary and validation cohorts.Conclusions: Our model is a novel prediction tool for CRT risk that accurately assigns cancer patients into high- and low-risk groups. Our model will be valuable for clinicians when making decisions regarding thromboprophylaxis.

Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: a retrospective cohort study

To determine the prophylactic effect of using combined 1% alcoholic chlorhexidine gluconate and chlorhexidine gel-impregnated dressings (CGCD) on catheter-related thrombosis (CRT) in critically ill patients. This retrospective cohort study was performed in an intensive care unit from November 2009 to August 2014. The CRT incidence diagnosed with ultrasound examination was compared between patients applying CGCD and combined 10% aqueous povidone-iodine and standard transparent dressings (PITD) after central venous catheter insertion into the internal jugular vein for ≥ 48 h. CRT was stratified into early (within 7 days) and late (days 8–14) thromboses. Multivariate analyses using logistic regression models clarified the relationships between early- and late-CRT risks and skin antiseptic and catheter site dressing combinations. CRT occurred in 74 of 134 patients (55%), including 52 with early CRT and 22 with late CRT. Patients receiving CGCD had a significantly lower incidence of early CRT than those receiving PITD (odds ratio = 0.18; 95% confidence interval = 0.07–0.45, p < .001). No significant association was evident between using CGCD and late CRT (p = .514). Compared to PITD, CGCD reduced the CRT risk over 7 days in critically ill patients.UMIN Clinical Trials Registry: UMIN000037492.

Development and validation of a new clinical prediction model of catheter-related thrombosis in cancer patients.

e14031 Background: The central venous catheter brings convenience for drug delivery and improves comfort for cancer patients, it also causes serious complications. The most common one is catheter-related thrombosis (CRT). This study aimed to evaluate the incidence and risk factors of CRT in cancer patients, and to develop an effective prediction model for CRT in cancer patients. Methods: The development of our prediction model was based on the data of a retrospective cohort (n = 3131) from National Cancer Center. The validation of our prediction model was done in a prospective cohort from National Cancer Center (n = 685) and a retrospective cohort from Hunan Cancer Hospital (n = 61). The predictive accuracy and the discriminative ability were determined by the receiver operating characteristic curves and calibration plots. Results: Multivariate analysis demonstrated that sex, cancer type, catheter type, position of the catheter tip, chemotherapy status, and antiplatelet/anticoagulation status at baseline were independent risk factors for CRT. The area under receiver operating characteristic (ROC) curve of our prediction model was 0.741 (CI: 0.715-0.766) in the primary cohort; 0.754 (CI: 0.704-0.803) and 0.658 (CI: 0.470-0.845) in validation cohorts respectively. Good calibration and clinical impact were also shown in primary and validation cohorts. The high-risk group had a higher incidence of CRTs than the low-risk group in the primary cohort and two validation cohort (p &lt; 0.001). Conclusions: Our model is a novel prediction tool for CRT risk which helps to assigning cancer patients into high-risk or low-risk group accurately. Our model will be valuable for clinicians in decision making of thromboprophylaxis.

Application of axillary vein puncture and catheterization based on Nickalls' landmarks in treating patients with multiple injuries

Objective To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients. Methods A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018. There were 48 males and 35 females, aged 21-84 years [(56.5±14.3)years]. The body mass index ranged from 19.8 to 43.1 kg/m2 [(27.6±6.5)kg/m2]. There were 26 patients with mainly craniocerebral injury, 15 with mainly thoracic injury, 28 with mainly abdominal injury, eight with mainly spinal injury and six with mainly pelvic fracture. The injury severity score (ISS) ranged from 24 to 66 points [(41.8±18.1)points]. All the patients received the axillary CVC based on Nickalls' landmarks. The left axillary vein was used as the puncture vein in 16 patients (left group), and the right axillary vein was used as the puncture vein in 67 patients (right group). A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group), while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group). The success rate of catheterization, pneumothorax, hematoma or artery injury, catheter ectopia, catheter-related infection and catheter-related thrombosis were recorded. Results A total of 80 patients were successfully intubated, with a success rate of 96%. Subgroup analysis showed that the success rate of right group was [97% (65/67)], slightly higher than that of the left group [94%(15/16)] , but the difference was not statistically significant (P>0.05). And the success rate of adjacent fracture group [94%(34/36)] was similar to that of non-adjacent fracture group [98%(46/47)], and the difference was not statistically significant (P>0.05). Complication incidences were as follows: hematoma or arterial injury [5%(4/83)], pneumothorax 2%(2/83), catheter-related thrombosis [12%(10/83)], and catheter ectopia [1%(1/83)]. No catheter-related infection was observed. Subgroup analysis showed that the incidence of various complications was similar between the left group and the right group (hematoma or arterial injury: 6% vs. 4%, pneumothorax: 0% vs. 3%; catheter ectopic: 0% vs. 1%; catheter-related thrombosis: 13% vs. 12%), and the difference was not statistically significant (P>0.05). The incidence of various complications was also similar between the adjacent fracture group and the non-adjacent fracture group (hematoma or arterial injury: 3% vs. 6%; pneumothorax: 3% vs. 2%; catheter ectopic: 0% vs. 2%; catheter-related thrombosis: 17% vs. 9%), and the difference was not statistically significant (P>0.05). Conclusions Axillary CVC based on Nickalls' landmark has a relatively high catheterization success rate and low complication incidence in adult multiple trauma patients. It is applicable to both left and right sides of axillary vein and suitable for patients with adjacent fracture. However, there still exists a high risk of catheter-related thrombosis, requiring enhanced anticoagulation and regular monitoring of thrombosis during catheterization. Key words: Multiple trauma; Axillary vein; Catheterization, central venous

Role of serial ultrasound screening of venous thrombosis in oncologic children with central lines

ObjectivePediatric oncology patients are more likely to develop venous thromboembolic events related to central venous catheter (CVC). Study aim was to determine the incidence of catheter related thrombosis (CRT) in a cohort of pediatric oncology patients using vascular ultrasound (US). MethodsConsecutive children of a single cancer referral center, requiring medium to long term CVC implantation, were screened for CRT, using serial ultrasound exams. Measurements and main resultsUS examinations were taken 15, 30 and 90 days after CVC implantation. A total of 113 catheters were studied in 103 patients (median age 10.5 years old). Ultrasound screening was completed in 80.5% patients. Apart from three subjects, US investigations were well tolerated. Patients were followed for a median of 87 days. No symptomatic CRT was recorded throughout. Three cases of asymptomatic thrombosis were identified with early US screening; incidence of CRT events for 1000 catheter-days was 0.11. The presence of previous catheter-related infection and an history of one or more previous CVC placement were identified as risk factors. ConclusionsIn our pediatric patients the incidence of CRT is low. Ultrasound monitoring is well tolerated and allows detecting asymptomatic CRT. Patients with previous CVC infection or insertion seem to have a higher risk of CRT (p =0.003 and p = 0.043 respectively).