| Background and Objective:PICC (Peripherally inserted central catheters) is a central vascular access inserted through the peripheral vein of the arm such as basilic vein, median vein or cephalic vein. In recent years, the clinical use of PICC has gradually increased as well as the complications of PICC especially thrombosis. VTE(Venous thromboembolism) encompasses deep venous thrombosis and pulmonary thromboembolism, which is the second largest cause of death in patients with malignant tumors. PICC-related Upper Extremity venous thrombosis is the formation of blood clots in the vessel or adhesive wall of the catheter which causes discomfort, interrupts treatment, increases the risk of catheter-related bloodstream infection and may even associated with increased morbidity and mortality. The recent researches are focus on deep venous thrombosis and pulmonary thromboembolism, the reports about PICC-Upper Extremity venous thrombosis is very limited and the associated risk factors is not very clear.In our study, we evaluate the clinical features and influence factors of symptomatic Peripherally inserted central catheter thrombosis in cancer patients and provide the basis for the prevention and treatment of the disease. Methods:Retrospective analysis method to analyze the clinical features and influence factors of the patients who received PICCs from1March2011to30September2013.Results:1. Of3794patients,27(0.71%) were found to have symptomatic PICC-related upper extremity vein thrombosis in cancer patients. The male to female ratio of the27patients was1:0.59, and mean age was60.93±11.78years old.2. The mean time interval from PICC insertion to thrombosis onset was48.63±79.26days, and55.56%happened in two weeks.3. Among the27patients, the thrombosis of10occurred in basilic vein,4in axillary vein,3in brachial vein,1in cephalic vein,1in subclavian vein,5in both brachial and axillary vein,1in both basilic and axillary vein,1in basilica, axillary and subclavian vein.4. The clinical manifestation was swell, ache, skin redness, ecchymosis, etc.92.59%patients showed swell.5.8patients were treated with low molecular heparin,9with warfarin and low molecular heparin,5removed of the PICC while with low molecular heparin,5only with warfarin,1removed the PICC while with low molecular heparin and warfarin.17patients (62.96%) rechecked by B-ultrasonic and found no embolus,4(14.81%)found the thrombus partially reabsorbed,6(22.22%) had a clinically significant improvement, no one had pulmonary embolism.6. The PICC-UEVT of lung cancer, gastric carcinoma, colorectal cancer, breast cancer, pharyngolaryngeal cancer, pancreatic carcinoma and carcinoma of urinary bladder was1.79%,0.47%,0.39%,0.48%,2.72%,0.69%,1.04%,1.96%. The incidence of lung cancer significantly higher than colorectal cancer (χ2=5.124, P＜0.05), the incidence of pharyngolaryngeal cancer significantly higher than colorectal cancer (χ2=5.989, P<0.05), gastric carcinoma(χ2=4.618, P<0.05), breast cancer (x2=4.335, P<0.05).7. The tumor metastasis was the major risk factor for PICC-UEVT by Conditional logistic regression(OR130.951, P<0.05). Conclusion:1. The patients with tumor metastasis especially pharyngolaryngeal cancer and lung cancer should be carefully estimated (D-dimer, etc.) before cathetering, and they should be paid more attention after cathetering.2. Choose a smaller and single lumen catheter to reduce the risk of PICC-UEVT.3. More attention should be paid in two weeks after the insertion of PICC, we should do a B-ultrasonic examination as soon as the clinical symptoms occurred such as swell, ache, etal to early detection of the thrombosis. |
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