The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Mich; Department of Internal Medicine, Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, Mich; VA Ann Arbor Health Care System, Ann Arbor, Mich.
The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Mich; Department of Internal Medicine, Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, Mich.
Am J Med. 2015 Sep;128(9):986-93.e1. doi: 10.1016/j.amjmed.2015.03.028. Epub 2015 May 1.
Peripherally inserted central catheters are associated with upper-extremity deep vein thrombosis. Whether they also are associated with lower-extremity deep vein thrombosis or pulmonary embolism is unknown. We examined the risk of venous thromboembolism in deep veins of the arm, leg, and chest after peripherally inserted central catheter placement.
We conducted a multicenter, retrospective cohort study of 76,242 hospitalized medical patients from 48 Michigan hospitals. Peripherally inserted central catheter presence, comorbidities, venous thrombosis risk factors, and thrombotic events within 90 days from hospital admission were ascertained by phone and record review. Cox proportional hazards models were fit to examine the association between peripherally inserted central catheter placement and 90-day hazard of upper- and lower-extremity deep vein thrombosis or pulmonary embolism, adjusting for patient-level characteristics and natural clustering within hospitals.
A total of 3790 patients received a peripherally inserted central catheter during hospitalization. From hospital admission to 90 days, 876 thromboembolic events (208 upper-extremity deep vein thromboses, 372 lower-extremity deep vein thromboses, and 296 pulmonary emboli) were identified. After risk adjustment, peripherally inserted central catheter use was independently associated with all-cause venous thromboembolism (hazard ratio [HR], 3.16; 95% confidence interval [CI], 2.59-3.85), upper-extremity deep vein thrombosis (HR, 10.49; 95% CI, 7.79-14.11), and lower-extremity deep vein thrombosis (HR, 1.48; 95% CI, 1.02-2.15). Peripherally inserted central catheter use was not associated with pulmonary embolism (HR, 1.34; 95% CI, 0.86-2.06). Results were robust to sensitivity analyses incorporating receipt of pharmacologic prophylaxis during hospitalization.
Peripherally inserted central catheter use is associated with upper- and lower-extremity deep vein thrombosis. Weighing the thrombotic risks conferred by peripherally inserted central catheters against clinical benefits seems necessary.
外周置入中心静脉导管与上肢深静脉血栓形成有关。但它们是否也与下肢深静脉血栓形成或肺栓塞有关尚不清楚。我们研究了外周置入中心静脉导管置管后手臂、腿部和胸部深静脉发生静脉血栓栓塞的风险。
我们对来自密歇根州 48 家医院的 76242 名住院内科患者进行了一项多中心、回顾性队列研究。通过电话和病历回顾确定外周置入中心静脉导管的存在、合并症、静脉血栓形成危险因素以及住院后 90 天内的血栓栓塞事件。采用 Cox 比例风险模型，在校正患者水平特征和医院内自然聚类后，检验外周置入中心静脉导管置管与 90 天内上肢和下肢深静脉血栓形成或肺栓塞的风险比。
共有 3790 例患者在住院期间接受了外周置入中心静脉导管。从住院到 90 天，共确定了 876 例血栓栓塞事件（208 例上肢深静脉血栓形成、372 例下肢深静脉血栓形成和 296 例肺栓塞）。在风险调整后，外周置入中心静脉导管的使用与全因静脉血栓栓塞（风险比 [HR]，3.16；95%置信区间 [CI]，2.59-3.85）、上肢深静脉血栓形成（HR，10.49；95% CI，7.79-14.11）和下肢深静脉血栓形成（HR，1.48；95% CI，1.02-2.15）独立相关。外周置入中心静脉导管的使用与肺栓塞无关（HR，1.34；95% CI，0.86-2.06）。纳入住院期间接受药物预防治疗的敏感性分析结果稳健。
外周置入中心静脉导管的使用与上肢和下肢深静脉血栓形成有关。权衡外周置入中心静脉导管带来的血栓形成风险与临床获益似乎是必要的。
