Allen A W, Megargell J L, Brown D B, Lynch F C, Singh H, Singh Y, Waybill P N
Division of Cardiovascular and Interventional Radiology, Pennsylvania State University Hospital, Hershey, USA.
J Vasc Interv Radiol. 2000 Nov-Dec;11(10):1309-14. doi: 10.1016/s1051-0443(07)61307-4.
Peripherally inserted central catheters (PICCs) have become an essential component of the management of an increasing number of patients, including patients who may require hemodialysis. Reported symptomatic venous thrombosis rates associated with PICC lines are based on clinical signs and symptoms and range from 1% to 4%. The purpose of this study is to evaluate the true rate of thrombosis of upper extremity veins after the placement of PICCs and the potential impact on future access in hemodialysis patients.
A retrospective analysis was performed. Patients who had (i) normal findings during initial venography, (ii) PICC placement, and (iii) who underwent subsequent repeated venography were included. Age, sex, vein cannulated, catheter size, location, and incidence of thrombosis were analyzed.
Three hundred fifty-four PICCs were placed in 119 patients. Of the 144 extremities, 137 had normal findings during initial venography. Of the 137 extremities, 32 developed thrombosis of the cannulated vein (or central veins) after initial PICC placement (23.3%). When all extremities with multiple PICC lines placed were considered, 52 developed thrombosis, for an overall thrombosis rate of 38%. The incidence of thrombosis by site was cephalic 57%, basilic 14%, and brachial 10%. No significant differences were noted in the rates of thrombosis by age, sex, or catheter size.
There is a relatively high rate of venous thrombosis associated with PICCs, particularly cephalic thrombus. Because of the high rate of thrombosis associated with these catheters, an alternative mode of access should be considered in current or potential hemodialysis patients. All patients with a history of PICC line placement requiring dialysis access should undergo upper extremity venography prior to the placement of permanent access.
经外周静脉穿刺中心静脉导管（PICC）已成为越来越多患者治疗的重要组成部分，包括可能需要血液透析的患者。报道的与PICC相关的有症状静脉血栓形成率是基于临床症状和体征，范围为1%至4%。本研究的目的是评估PICC置管后上肢静脉血栓形成的真实发生率以及对血液透析患者未来血管通路的潜在影响。
进行回顾性分析。纳入的患者需满足以下条件：（i）初次静脉造影结果正常；（ii）进行了PICC置管；（iii）随后接受了重复静脉造影。分析患者的年龄、性别、置管静脉、导管尺寸、位置以及血栓形成的发生率。
119例患者共置入354根PICC。在144条肢体中，137条在初次静脉造影时结果正常。在这137条肢体中，32条在初次PICC置管后出现了置管静脉（或中心静脉）血栓形成（23.3%）。当考虑所有置入多根PICC的肢体时，52条出现血栓形成，总体血栓形成率为38%。按部位划分，头静脉血栓形成发生率为57%，贵要静脉为14%，肱静脉为10%。在血栓形成率方面，年龄、性别或导管尺寸之间未发现显著差异。
PICC相关的静脉血栓形成率相对较高，尤其是头静脉血栓。由于这些导管相关的血栓形成率较高，对于当前或潜在的血液透析患者应考虑采用其他血管通路方式。所有有PICC置管史且需要透析通路的患者在置入永久性通路前应进行上肢静脉造影。
