Retrospective cohort analysis comparing the incidence of deep vein thromboses between peripherally-inserted and long-term skin tunneled venous catheters in hemato-oncology patients

Abstract

BackgroundThe introduction of central venous catheters has advanced medical care, particularly in hemato-oncology. However these can be associated with an increased thrombotic risk. Previous studies have compared the rate of thrombotic events between peripherally- inserted (PICCs) and long term skin tunneled catheters (LTSTCs) noting fewer complications associated with the latter, though this has rarely translated into clinical practice. The objectives of our study was to compare the cumulative incidence of thrombotic events between peripherally-inserted and long term skin tunneled venous catheters.Patients/methodsWe performed a retrospective, single center cohort analysis of patients with hematological malignancies who had either a PICC or LTSTC line inserted between January 2010 through January 2013. Cumulative incidences of thrombotic events were compared between the two groups, and post-thrombotic complications were also examined.Results346 patients had a PICC inserted with cumulative incidence of symptomatic thrombosis of 5.8%, while 237 patients had a LTSTC inserted with a cumulative incidence of 1.7% (p = 0.003). Post-thrombotic complication rates, particularly infection, were higher in the PICC group compared to the LTSTC group (p = 0.597).ConclusionsOur study showed that the incidence of thrombotic events in hemato-oncology patients was significantly lower in those who had a LTSTC compared to PICC line. As the use of central venous lines increases in hemato-oncology patient care, a randomized trial comparing PICCs and LTSTCs is necessary to address which venous access is most appropriate in this cohort of patients, with minimal risk of morbidity and mortality.

Peripherally inserted central catheters (PICCs) in cancer patients under chemotherapy: A prospective study on the incidence of complications and overall failures

“…Symptomatic UEDVT was the first reason for failure accounting for more than one‐fourth of all failures. Our findings were consistent with those reported in large series of pooled oncological and non‐oncological patients ; noteworthy, studies in which PICCs were implanted solely in cancer patients reported UEDVT rates ranging from 1% to 50% . In our study, nearly one‐half of the PICC‐UEDVT were rescued by the implementation of an early treatment with low weight molecular heparin that allowed to continue their use until the end of treatment.…”

“…In our study dwell times for PICC removals for different that CLABSI or exit site complications ranged from 50 to 97 days, notably longer to that of literature reports. In particular, for UEDVT, it was 72 days while literature reports this complication to occur within the first months after PICC implant . In our opinion, this was due to some factors: (i) the systematic use of ultrasound guidance for placement; (ii) choice of a vein with an appropriate catheter to vein ratio; (iii) the consistent use of single‐lumen PICCs; (iv) a routine control of the correct tip position; and (v) the use of institutional evidence‐based nursing protocols .…”

The Use of Peripherally Inserted Central Catheter in Amyotrophic Lateral Sclerosis Patients at a Later Stage

“…Additionally, mechanical complications are rare, 0.29/1,000, compared to the series described in ALS with an incidence of 1.09/1,000. Indeed, advantages of PICC make it an easier and safer option due to its placement, the absence of pneumothorax, and rare malpositions [5,8] . Pneumothorax may have immediate and life-threatening consequences and in ALS, this is an important concern.…”

“…However, in some cases, gastrostomy is non-feasible because of dementia, patient refusal, gastric malposition, or severe respiratory insufficiency [2][3][4] . In those cases, parenteral nutrition (PN) is usually administered through a central venous catheter (CVC) with an implantable port [5] . The use of CVC has been described in a series of disorders including ALS [6] .…”

Peripherally Inserted Central Venous Catheter in Upper Extremities Could be a Risk for Deep Vein Thrombosis in Lower Extremities and D-Dimer in Neurology Department

“…However, PICC insertion and displacement will damage the vascular intima [2], The presence of PICC occupies part of the inner diameter of the vein [3,4], coupled with the patients' own diseases and medication induced hypercoagulable state [5], just meet the Virchow's triad [6]. The incidence of PICC related upper extremity deep venous thrombosis(UEDVT) was 51.4% − 71.9% [7][8][9]. Among them,patients who appear peripheral symptoms like limb swelling, local tenderness, skin temperature rise, skin color cyanosis, limb dysesthesia and dyskinesia or shoulder discomfort were 2.0% − 27.9% [10][11][12].…”