Incidence And Risk Factors Of Upper Extremity Deep Venous Thrombosis Associated With Peripherally Inserted Central Venous Catheters

ObjectiveTo investigate the incidence and risk factors associated with peripherally inserted central venous catheters(PICC)-related upper extremity deep venous thrombosis through the prospective studies. At the same time, investigate the predilection period and prone parts of upper extremity deep venous thrombosis associated with PICC. To provide information for the development of PICC-related upper extremity deep venous thrombosis risk assessment scale, with the aim of finding the proper time to apply color Doppler for high-risk groups assessing the occurrence of thrombosis, and provide evidence for early detection and intervention of thrombosis.MethodsA total of 100 general surgery and gynecology department patients who were scheduled to receive PICC in a hospital of Tianjin between March 2014 and October2014, were prospectively studied. Recorded general information of patients,disease-related information, information about the vessel selected to puncture and puncture technique, they were investigated for venous thrombosis by Doppler sonography every seven days within one month after catheter insertion.Used SPSS17.0 statistical software for data analysis and processing. The difference in the incidence of thrombosis between different groups were examined for statistical significance with t test, chi-square and multivariable logistic regression analysis was applied for identification of the risk factors for PICC related upper extremity deep venous thrombosis.Results(1)A total of 100 patients were studied in our research. Of these, 98 patients were followed up within 4 weeks. Among the 98 patients, 26 patients were found have thrombosis. The incidence of PICC-related upper extremity deep venous thrombosis was 26.5%(26/98), among these patients, 21 without any significant symptoms,constituted 80.8%.(2)Among the 26 patients with thrombosis, 11 patients occurred in the first week,9 patients occurred in the second week, 4 patients occurred in the third week, 2patients occurred in the fourth week. Statistical analysis was significant difference,the incidence of PICC related upper extremity deep venous thrombosis in two weeks after catheter insertion was higher.(3)Among the patients with thrombosis, 18 patients occurred in the axillary vein,8 patients occurred in the brachial vein and 6 patients occurred in the subclavian vein,a higher incidence of axillary vein was the prone parts of PICC related upper extremity deep venous thrombosis.(4)The univariate analysis showed that the diameter of blood vessel, CVC or PICC catheter history, cancer, chemotherapy history, history of thrombosis were significant differences between patients with and without thrombosis. The multivariable analyses showed that the diameter of blood vessel(OR=3.807,P=0.013), previous CVC insertion(OR=9.126, P=0.016), history of thrombosis(OR=62.492,P=0.005) were the factors for thrombosis.Conclusions(1)The incidence of PICC-related upper extremity deep venous thrombosis was relatively high, and most cases had no significant symptoms, which should arouse our attention. Ultrasound played an important role in early detection and diagnosis of upper extremity deep vein thrombosis.(2)The higher incidence period of PICC related upper extremity deep venous thrombosis was two weeks after catheter insertion. Recommended strengthen the cooperation of doctors and nurses, applying routinely B-ultrasound examination two weeks after the insertion of PICC.(3)Axillary vessels was easily occurred thrombosis after PICC insertion,attention should be paid for exercise and care of the side of limb with PICC.(4)The diameter of blood vessel, CVC or PICC catheter history, cancer,chemotherapy history, history of thrombosis were associated with PICC related upper extremity thrombosis; The diameter of blood vessel, CVC or PICC catheter history,history of thrombosis were the key risk factors for PICC related upper extremity thrombosis. Nurse should assess the risks before PICC inserted.