Study On Risk Factors Of PICC Catheter-related Deep Vein Thrombosis In Upper Extremity And Analysis Of Prevention And Treatment Strategies

Objective:The purpose of this study was to investigate the incidence of upper extremity deep venous thrombosis(UEDVT)related to peripherally inserted central catheter(PICC)in a third grade class-A hospital,to screen the risk factors of PICC-related UEDVT and to construct a PICC-related UEDVT risk assessment model.Furthermore,Meta analysis was used to evaluate the preventive effect of physical prevention on thrombus which could better help medical staff screen and prevent the occurrence of PICC-related UEDVT.Methods:In this study,300 patients who received PICC catheterization in our hospital from June 2018 to December 2019 were selected by convenience sampling.At week 1,week 2,week 3,and week 4 after catheterization,color doppler was used to examine whether thrombosis formed in the brachial vein,axillary vein and other veins of the upper extremity at the side of catheterization.Then,SPSS 19.0 was used for univariate analysis of patients' general data,PICC catheterization related data,laboratory examination data before catheterization,and anticoagulant treatment data,etc.The OR and P values of the factors with P<0.05 in the univariate analysis were obtained by Logistic multivariate regression analysis,and the picc-related UEDVT risk assessment model was further constructed.Results:Single factor analysis shows:among the 300 patients,91(30.33%)were diagnosed with thrombus,among which 38 were accompanied by severe symptomatic thrombus and 53 were asymptomatic thrombus.There were 71 cases with picc-related UEDVT within 1 to 2 weeks,and the difference between the number of cases with picc-related UEDVT within 2 to 4 weeks was statistically significant(P<0.05).Fifty-two patients with picc-associated UEDVT grade 1 occurred within 4 weeks after catheterization,and the difference in the number of thrombosis cases between the symptoms of grade 1,2 and 3 was statistically significant(P<0.05).1.Single factor analysis results show that:The differences in body mass index,age,physical condition,history of radiotherapy,peripheral atherosclerosis,history of deep vein thrombosis,limb muscle strength at the catheterization side,location of catheter tip,catheter-related infection,d-dimer content,fibrinogen content,leukocyte content and erythrocyte content between the two groups were statistically significant(P<0.05).2.Multivariate Logistic regression analysis showed that:Body mass index,history of radiotherapy,physical strength,peripheral atherosclerosis,history of deep vein thrombosis,limb muscle strength at the catheterization side,location of catheter tip,catheter-related infection,d-dimer content and fibrinogen content were independent risk factors for picc-related UEDVT(P<0.05).The risk prediction and analysis model of picc-related UEDVT was Y=3× body mass index+3× history of radiotherapy+1×physical condition+2× peripheral atherosclerosis+4× history of deep vein thrombosis+4× limb muscle strength at the catheterization side+6× location of catheter tip+4×catheter related infection+1× d-dimer content+1× fibrinogen content.3.Meta-analysis results showed that:Various forms of upper limb movement could effectively reduce the incidence of venous thrombosis in patients with PICC catheterization(P=0.0001)and improve the average venous blood flow velocity at the catheterization side(P=0.0001).Conclusion:Body mass index,history of radiotherapy,physical condition,peripheral atherosclerosis,history of deep vein thrombosis,limb muscle strength at the side of catheterization,location of catheter tip,catheter-related infection,d-dimer content,and fibrinogen content were independent risk factors for the occurrence of picc-related UEDVT.Various forms of upper limb movement can effectively reduce the incidence of venous thrombosis in patients with PICC catheterization,which is worthy of clinical promotion.