The risk of venous thromboembolism associated with peripherally inserted central catheters in ambulant cancer patients

Abstract

BackgroundDeep vein thrombosis (DVT) is a common complication of peripherally inserted central catheters (PICCs). PICCs are increasingly utilised in the management of cancer patients, a group which carries both additional risks for vascular thromboembolism as well as for complex morbidity. We analysed a cohort of cancer patients subjected to PICC insertion in a single cancer centre for the incidence of all-type vascular thromboembolism (VTE) and investigated relative risk factors.MethodsIn this clinical audit, the records of patients referred for PICC insertion in our centre in the period between 1/1/2011 and 1/4/2014 were retrospectively reviewed. The primary outcomes investigated were a) PICC-related deep vein thrombosis (PRDVT) and b) distant VTE (lower limb DVT and pulmonary embolism). 4Fr single lumen PICCs were placed in all patients. The Kaplan Meier method was used to study time from PICC insertion to PRDVT/VTE. Survival curves were compared using the log rank method. Logistic and Cox regression analyses were used to assess local, distant and combined endpoints.ResultsFour hundred ninety patients were included in the analysis of which 27 (5.5%) developed a PRDVT. Statistically significant risk factors for developing PRDVT in multivariate analysis included more than one attempt for insertion (OR 2.61, 95%CI: 1.12–6.05) and the use of fluoropyrimidine containing chemotherapy (OR 4.27, 95%CI 1.3–14.07). Twenty-six patients developed a distant VTE. Male gender was the only significant risk factor for distant VTE. When all-type VTE were considered together fluoropyrimidine containing chemotherapy (OR 4.54, 95% CI 1.63–12.61), male gender (OR 2.03, 95% CI 1.04–3.93) and white cell count (OR 1.12, 95% CI 1.00–1.26) were statistically significant as risk factors in this analysis.ConclusionsThis is a large study of VTE following PICC insertion in cancer patients which also looks at the rate of distant VTE. The observed PRDVT incidence is comparable with available literature. Fluoropyrimidine containing chemotherapy and more than one attempt for PICC insertion were independent predictors of PICC-associated VTE whilst the former remained an independent predictor of all-type VTE. Anticoagulation did not prevent thrombotic events in this cohort.

Incidence and Risk Factors of Peripherally Inserted Central Catheter-related Complications in Patients with Diabetes: A Retrospective Study

“…Previous studies have explored risk factors for PICC complications such as gender, body mass index, but no consensus has been reached yet [13][14][15]. Our study focused on diabetic patients and found married status and surgical history were the influencing factors of PICC-related complications.…”

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

“…PICC is placed in a much smaller vein than in CVC, and the risk of DVT in PICC is 2.5 times higher than that in CVC [31], of which 33-60% were asymptomatic [32]. It is easy to understand that PICC is the most important risk factor for UEDVT [33,34], but the presence of PICC in this study increased the risk of LEDVT by 7 times (or = 7.048 [95% CI: 0.05] .It has been speculated that endothelial injury, vascular reactivity and coagulation promotion may lead to PICC related deep venous thrombosis, which extends beyond the vascular bed of PICC itself, but lacks systemic coagulation indicators to con rm this association.…”

Complications and Risk Factors of Peripherally Inserted Central Catheters: A Review

“…Bertoglio S reported 25% developed complications with 12% UEDVT and 2% CLABSI [20]. Jones D found 5.5% developed UEDVT and risk factors for UEDVT were more than one attempt for insertion and the use of fluoropyrimidine containing chemotherapy, 5.3% developed thromboembolism and male gender was the risk factor [11]. Rykov MY reportrd 4.5% catheter-related thrombosis and 0% CLABSI [21].…”

“…Various studies have reported PICC-related complications: Jennifer M et al reported a 11.77% rate of PICC-related complication including 3% catheter-associated thrombosis, 4% mechanical complications, 2% CRBSI, and 1% cellulitis [8]; Junren K showed 17.0% developed PICC-related complications with 4.6% skin allergy, 1.9% upper extremity deep venous thrombosis (UEDVT) and 1.3% CLABSI [6]. The incidence of PICC-related complications raised concerns on their use and several studies have tried to explore risk factors of PICC-related complications [9][10][11], but no unanimous conclusion has been reached so far. In this study, we reviewed the literature on PICC-related complications and risk factors to reduce the incidence of complications, disease burden, and health care cost.…”