Bhargava M, Broccard S, Bai Y, Wu B, Dincer E H, Broccard A
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Mayo Clinic, Jacksonville, FL, USA.
SAGE Open Med. 2020 Jun 4;8:2050312120929238. doi: 10.1177/2050312120929238. eCollection 2020.
Central venous access using peripherally inserted central catheters is frequently used for patients receiving intravenous medications in the hospital or outpatients. Although there are several benefits of peripherally inserted central catheters, such as ease of insertion, low procedure-related risk and higher patient satisfaction, there are complications associated with peripherally inserted central catheter use. Despite some studies evaluating peripherally inserted central catheter line-related complications, the factors associated with peripherally inserted central catheter-related deep venous thrombosis in critically ill medical-surgical patients are poorly described. The objective of this case-control study was to identify the risk factors associated with peripherally inserted central catheter line-related deep venous thrombosis in critically ill medical-surgical intensive care unit patients in a community hospital.
We abstracted relevant clinical data from 21 cases with symptomatic peripherally inserted central catheter-related deep venous thrombosis and 42 controls with peripherally inserted central catheters but no deep venous thrombosis.
Of the factors evaluated, female gender, the use of triple lumen peripherally inserted central catheters, larger outer diameter, and open (vs valve) peripherally inserted central catheters were associated with venous thrombosis. In this retrospective study, we did not identify any association of peripherally inserted central catheter-related deep venous thrombosis with a prior history of deep venous thrombosis, use of alteplase, antiplatelet therapy, prophylactic or therapeutic anticoagulation, international normalized ratio, platelet count and the use of peripherally inserted central catheters for total parenteral nutrition.
Our study indicates that the catheter size relative to the diameter of the vein could be an important risk factor for the development of peripherally inserted central catheter-related deep venous thrombosis. The study findings should be confirmed in a larger study designed to identify risk factors of peripherally inserted central catheter-related deep venous thrombosis. In the meantime, the peripherally inserted central catheter lines should be used judiciously in critically ill patients.
使用外周静脉穿刺中心静脉导管进行中心静脉通路建立，在医院接受静脉用药的患者或门诊患者中经常被采用。尽管外周静脉穿刺中心静脉导管有诸多益处，如易于插入、与操作相关的风险低以及患者满意度较高，但使用外周静脉穿刺中心静脉导管也存在并发症。尽管有一些研究评估了外周静脉穿刺中心静脉导管相关并发症，但对于重症内科 - 外科患者中与外周静脉穿刺中心静脉导管相关的深静脉血栓形成的相关因素描述甚少。本病例对照研究的目的是确定社区医院重症内科 - 外科重症监护病房患者中与外周静脉穿刺中心静脉导管相关的深静脉血栓形成的危险因素。
我们从21例有症状的外周静脉穿刺中心静脉导管相关深静脉血栓形成患者和42例有外周静脉穿刺中心静脉导管但无深静脉血栓形成的对照患者中提取了相关临床数据。
在所评估的因素中,女性、使用三腔外周静脉穿刺中心静脉导管、较大的外径以及开放式（相对于瓣膜式）外周静脉穿刺中心静脉导管与静脉血栓形成相关。在这项回顾性研究中，我们未发现外周静脉穿刺中心静脉导管相关深静脉血栓形成与既往深静脉血栓形成病史、使用阿替普酶、抗血小板治疗、预防性或治疗性抗凝、国际标准化比值、血小板计数以及使用外周静脉穿刺中心静脉导管进行全胃肠外营养之间存在任何关联。
我们的研究表明，相对于静脉直径的导管尺寸可能是外周静脉穿刺中心静脉导管相关深静脉血栓形成的一个重要危险因素。该研究结果应在一项旨在确定外周静脉穿刺中心静脉导管相关深静脉血栓形成危险因素的更大规模研究中得到证实。与此同时，在外周静脉穿刺中心静脉导管的使用上，应谨慎对待重症患者。
