外周置入中心静脉导管使用模式与相关的症状性上肢静脉血栓形成。

Peripherally inserted central catheter usage patterns and associated symptomatic upper extremity venous thrombosis.

机构信息

Division of Vascular Surgery, Oregon Health and Science University, Portland, OR 97239, USA.

出版信息

J Vasc Surg. 2012 Mar;55(3):761-7. doi: 10.1016/j.jvs.2011.10.005.

DOI:10.1016/j.jvs.2011.10.005

PMID:22370026

Abstract

OBJECTIVES

Peripherally inserted central catheters (PICCs) may be complicated by upper extremity (UE) superficial (SVT) or deep venous thrombosis (DVT). The purpose of this study was to determine current PICC insertion patterns and if any PICC or patient characteristics were associated with venous thrombotic complications.

METHODS

All UE venous duplex scans during a 12-month period were reviewed, selecting patients with isolated SVT or DVT and PICCs placed ≤30 days. All UE PICC procedures during the same period were identified from an electronic medical record query. PICC-associated DVTs, categorized by insertion site, were compared with all first-time UE PICCs to determine the rate of UE DVT and isolated UE SVT. Technical and clinical variables in patients with PICC-associated UE DVT also were compared with 172 patients who received a PICC without developing DVT (univariable and multivariable analysis).

RESULTS

We identified 219 isolated UE SVTs and 154 UE DVTs, with 2056 first-time UE PICCs placed during the same period. A PICC was associated with 44 of 219 (20%) isolated UE SVTs and 54 of 154 UE DVTs (35%). The rates of PICC-associated symptomatic UE SVT were 1.9% for basilic, 7.2% for cephalic, and 0% for brachial vein PICCs. The rates of PICC-associated symptomatic UE DVT were 3.1% for basilic, 2.2% for brachial, and 0% for cephalic vein PICCs (χ(2)P < .001). Univariate analysis of technical and patient variables demonstrated that larger PICC diameter, noncephalic insertion, smoking, concurrent malignancy, diabetes, and older age were associated with UE DVT (P < .05). Multivariable analysis showed larger catheter diameter and malignancy were the only variables associated with UE DVT (P < .05).

CONCLUSIONS

The incidence of symptomatic PICC-associated UE DVT is low, but given the number of PICCs placed each year, they account for up to 35% of all diagnosed UE DVTs. Larger-diameter PICCs and malignancy increase the risk for DVT, and further studies are needed to evaluate the optimal vein of first choice for PICC insertion.

摘要

目的

经外周静脉穿刺中心静脉置管（PICC）可能并发上肢（UE）浅静脉血栓形成（SVT）或深静脉血栓形成（DVT）。本研究旨在确定当前 PICC 置管模式，以及任何 PICC 或患者特征是否与静脉血栓并发症相关。

方法

回顾了 12 个月内所有 UE 静脉双功能超声检查，选择仅存在 SVT 或 DVT 且 PICC 置管时间≤30 天的患者。从电子病历查询中确定同期所有首次 UE PICC 置管。根据置管部位将 PICC 相关 DVT 分为，与所有首次 UE PICC 比较，以确定 UE DVT 和孤立 UE SVT 的发生率。还将 PICC 相关 UE DVT 患者的技术和临床变量与 172 例未发生 DVT 的 PICC 患者（单变量和多变量分析）进行比较。

结果

我们共发现 219 例孤立 UE SVT 和 154 例 UE DVT，同期共进行了 2056 例首次 UE PICC 置管。PICC 与 219 例孤立 UE SVT 中的 44 例（20%）和 154 例 UE DVT 中的 54 例（35%）相关。SVT 发生率分别为：贵要静脉置管 1.9%，头静脉置管 7.2%，肱静脉置管 0%。DVT 发生率分别为：贵要静脉置管 3.1%，肱静脉置管 2.2%，头静脉置管 0%（χ2P<0.001）。技术和患者变量的单变量分析表明，导管直径较大、非头静脉置管、吸烟、合并恶性肿瘤、糖尿病和年龄较大与 UE DVT 相关（P<0.05）。多变量分析显示，导管直径较大和恶性肿瘤是与 UE DVT 相关的唯一变量（P<0.05）。