Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5338, USA.
Neurocrit Care. 2011 Dec;15(3):454-60. doi: 10.1007/s12028-011-9554-3.
Peripherally inserted central venous catheters (PICCs) are being increasingly utilized in hospitalized patients as alternatives to centrally inserted central venous catheters (CICVCs). However, concern exists over the risk of PICC-related large vein thrombosis (PRLVT). The incidence rate and significance of symptomatic PRLVT in critically ill patients admitted to the neurological intensive care unit (ICU) is not known.
Retrospective descriptive study of consecutive PICCs placed in critically ill patients admitted to a tertiary care neurological ICU between March 2008 and February 2010. Symptomatic PRVLT was defined as an event that prompted Duplex ultrasound of the ipsilateral extremity in which an acute, proximal large vein thrombosis was confirmed in association with the PICC or confirmed within 5 days of PICC removal. Incidence rate of PRLVT and catheter-related complications were calculated per "line" (catheter). Descriptive statistics were performed with two-sample, and t-tests for age and categorical variables were assessed by Chi-square test or Fishers exact test as appropriate
Four hundred and seventy-nine lines were placed during the study period with 39 developing a symptomatic PRLVT (incidence rate = 8.1%). Male gender was associated with development of a thrombosis (P = 0.02), but size (P = 0.21) and location of catheter were not (P = 0.30). Median line dwell time was 12 days (IQR 16) with a dwell time of 8 days (IQR 9) until thrombosis diagnosis. Pulmonary embolus attributed to PRLVT occurred in 1.3% of line placements and 15% of symptomatic PRLVT. The majority of patients had their line removed. In addition, some patients also had anticoagulation initiated or a superior vena cava filter placed.
Symptomatic PRLVT is not uncommon in critically ill patients admitted to the neurological ICU. Future research should focus on indentifying modifiable risk factors for PRLVT and on comparing major cumulative complication rates between PICCs and CICVCs.
外周静脉置入中心静脉导管（PICC）作为中心静脉置管（CICVC）的替代方法，在住院患者中得到了越来越多的应用。然而，人们对 PICC 相关大静脉血栓形成（PRLVT）的风险存在担忧。在入住神经重症监护病房（NICU）的危重症患者中，有症状的 PRLVT 的发生率和意义尚不清楚。
对 2008 年 3 月至 2010 年 2 月期间在一家三级护理神经 NICU 住院的危重症患者连续进行的 PICC 置管回顾性描述性研究。有症状的 PRLVT 定义为提示对同侧肢体进行双功超声检查的事件，在该事件中，与 PICC 相关或在 PICC 拔除后 5 天内确认同侧近端大静脉急性血栓形成。计算每条导管（导管）的 PRLVT 和导管相关并发症的发生率。采用两样本 t 检验进行描述性统计，年龄和分类变量采用卡方检验或 Fisher 确切检验进行评估。
在研究期间共置管 479 条，其中 39 条发生有症状的 PRLVT（发生率为 8.1%）。男性与血栓形成的发生有关（P=0.02），但导管的大小（P=0.21）和位置与血栓形成无关（P=0.30）。中位导管留置时间为 12 天（IQR 16），直到血栓形成诊断的导管留置时间为 8 天（IQR 9）。归因于 PRLVT 的肺栓塞在导管置管中的发生率为 1.3%，在有症状的 PRLVT 中的发生率为 15%。大多数患者都拔除了导管。此外，一些患者还开始抗凝治疗或放置了上腔静脉滤器。
有症状的 PRLVT 在入住神经 NICU 的危重症患者中并不少见。未来的研究应集中于确定 PRLVT 的可改变危险因素，并比较 PICC 和 CICVC 的主要累积并发症发生率。
