Central Venous Catheter-related Thrombosis In Patients With Hematological Malignancies:A Retrospective Analysis Of Risk Factors

ObjectiveThe objective of this study was to compare the incidence rate of catheter-related thrombosis(CRT)between peripherally inserted central catheter(PICC)and venous port access(VPA)in patients with hematological malignancies,and determine the risk factors for CRT in patients with PICC in order to provide evidence for the prevention of CRT and reduce the risk of CRT.patients and MethodsAn observational cohort of 168 patients with hematologic malignancy was retrospectively studied following PICC or VPA insertion from June 2015 to May 2016.Color Doppler ultrasonography was performed on the patients who exhibited CRT related symptoms such as swelling,pain,tenderness,red skin and higher skin temperature.CRT was defined as thrombus was detected by Color Doppler ultrasonography in the inserted vein or other veins.The incidence rate of CRT and other complications between PICC and VPA was compared.This study analysed the risk factors for CRT,including patient related factors,disease related factors,catheter related factors and other factors.The patient related factors included gender,age,chronic disease,BMI,smoking,and prior catheter related events.The disease related factors include primary disease,the use of L-asparaginase,lenalidomide and erythropoiesis stimulating agents(ESA),the index of blood coagulation function,coagulation function and albumin at the time of catheterization.Catheter related factors included catheter type,site of insertion,placement of vein,catheter site,and indwelling days.Continuous variables were summarized as median with interquartile range(IQR)and categorical variables were described by frequency distributions.T test or the Wilcoxon-Mann-Whitney test was used to compare continuous variables.The chi-squared test or Fisher's exact test was employed to assess the association between two categorical variables.Multivariate analysis was performed by Losgitic regression analysis.Two-sided p values of<0.05 were considered as statistically significant.ResultsIn total,104 patients with PICC and 64 patients with VPA were enrolled in this study.The rates of CRT were 10.6%(11/104)and 1.6%(1/64)in group PICC and group VPA,respectively.There was obvious statistical difference between the two groups(p=0.031).The patients with PICC were divided into thrombus group(11 cases)and thrombus free group(93 cases)according to result of Color Doppler ultrasonography.The single factor analysis indicated that the risk factors included prothrombin time(PT)and activated partial thromboplastin time(APTT)shortened,BD4Fr,left catheterization,cephalic vein or brachial vein for catheterization,and the first 10 days after catheterization(p<0.05).The first 10 days after catheterization was an independent risk factor for CRT in PICC group which was studied by means of Losgitic regression analysis.Conclusions1.The incidence of CRT in patients with PICC was higher than that with VPA.2.The disease status at the time of catheterization including PT and APTT shortened was risk factor for CRT in PICC group.3.Catheter related factors,including BD4Fr,left catheterization,cephalic vein or brachial vein for catheterization,and the first 10 days after catheterization,were risk factors for CRT in PICC group,and the first 10 days after catheterization was the independent risk factor.4.Direct extubation is not advocated for acute CRT,and low molecular weight heparin and warfarin are recommended or implement other measures according to the different condition.