Effect of exercise therapy on PICC-associated venous thromboembolism: A meta-analysis

Abstract

Background Peripherally inserted central catheter (PICC) is widely used in clinical practice because of its long retention time and easy maintenance. However, PICC-associated venous thromboembolism (VTE) is the most serious complication of PICC. Guidelines recommend exercise therapy to prevent PICC-associated VTE. However, inconsistent findings have been reported across the literature. This study conducted a meta-analysis to further evaluate the effect of exercise therapy on PICC-associated VTE. Methods We searched CNKI, Wanfang database, Chinese Science and Technology Journal Full Text Database, PubMed, Embase, Web of Science and Cochrane Library databases and included all randomized controlled trials (RCTs) of exercise therapy for the prevention of PICC-associated VTE. Two investigators independently screened the literature, extracted information, and evaluated the risk of bias for eligible RCTs. Meta-analysis was conducted by RevMan5.4 software. Results Eleven RCTs were included, including 1919 patients. Meta-analysis showed that the incidence of PICC-associated VTE was lower in the exercise therapy group than in the usual care group (RR = 0.30, 95% CI: 0.22–0.41, p < 0.00001).Exercise therapy increased the axillary vein maximum velocity (SMD = 0.93, 95% CI: 0.58–1.28, p < 0.00001) and the axillary vein time-mean flow velocity (SMD = 0.86, 95% CI: 0.53–1.20, p < 0.00001). Subgroup analysis showed statistically significant differences for the incidence of PICC-associated VTE for intervention times<4 weeks (RR = 0.26, 95% CI: 0.17–0.40, p < 0.00001) and intervention times≥4 weeks (RR = 0.35, 95% CI: 0.22–0.54, p < 0.00001). For axillary vein maximum velocity, the difference was statistically significant for both intervention time <4 weeks (SMD = 0.73, 95% CI: 0.55–0.91, p < 0.00001) and intervention time ≥4 weeks (SMD = 1.18, 95% CI: 0.18–2.19, p = 0.02). For axillary vein time-mean flow velocity, the intervention time <4 weeks (SMD = 0.75, 95% CI: 0.46–1.04, p < 0.00001), and the difference was statistically significant; while ≥4 weeks, the difference was not statistically significant (SMD = 1.14, 95% CI: −0.07 to 2.35, p = 0.06). Conclusions Exercise therapy improved venous blood flow velocity and effectively reduced the incidence of PICC-associated VTE. However, RCTs with large samples and high quality are needed to further evaluate the effectiveness of exercise therapy in PICC patients.

The incidence and risk of different indwelling times of peripherally inserted central catheter-related venous thrombosis in cancer patients: a retrospective analysis of 654 patients

“…The lower incidence of thrombosis after 6 months of catheter insertion compared with the incidence within 1 month may be due to organic detachment thrombus or absorption by hemodilution during indwelling, and health care workers should strengthen thrombosis prevention, such as weekly or monthly routine Doppler ultrasound. It has been recommended that medical staff standardize early st exercises and hydration in cancer patients with PICC catheterization based on evidence-based studies, improve blood circulation in cancer patients, and increase health education to prevent and reduce the incidence of thrombosis [19,20].…”

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

“…This, in turn, leads to venous dilation, endothelial impairment, and the accumulation of coagulation factors that trigger the activation of the coagulation system, ultimately facilitating the development of thrombus. Consequently, numerous scholarly works have emphasized the significance of health education pertaining to mechanical prophylaxis, including healthcare practitioners advising patients to engage in upper limb relaxation and clenching at the site of peripheral central venous catheter insertion as a preventive measure against the formation of PICC-RVTE (20,21). Furthermore, our study specifically examined the association between a history of thrombosis within the previous 12 months and the formation of PICC-RVTE.…”