Lee Kee Wei, Cheong Chin Sum, Gin Gan Gin
Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Malays J Med Sci. 2024 Apr;31(2):52-61. doi: 10.21315/mjms2024.31.2.6. Epub 2024 Apr 23.
Peripherally inserted central venous catheters (PICC) are widely used in patients with haematological malignancies owing to the requirement for prolonged intravenous therapy. However, the growing use of PICCs has resulted in a multitude of complications such as infections and thrombosis, leading to prolonged hospitalisation periods and increased morbidity. This study aimed to determine the incidence of and factors associated with PICC-related complications in patients with haematological malignancies.
This prospective cohort study was conducted at a single academic institution. The inclusion criteria involved all adult patients with haematological malignancies who had newly inserted PICCs. The patients were observed for a minimum duration of 60 days to evaluate the incidence of PICC-related infections and thrombosis, as well as mechanical complications.
A total of 119 PICCs were implanted in 85 patients. Among them, more than half of the patients were diagnosed with lymphoma (55.0%). The median dwell time was 61 days (interquartile range: 98 days). The incidence of PICC-related complications was 58.0% (6.9 per 1,000 catheter-days). Specifically, 43 PICCs (36.1%, 4.3 per 1,000 catheter-days) experienced infective complications, 25 (21.1%, 2.5 per 1,000 catheter-days) encountered mechanical complications and 1 (0.8%, 0.1 per 1,000 catheter-days) exhibited thrombotic complications. Furthermore, an underlying diagnosis of acute leukaemia was significantly associated with a higher incidence of PICC-related infections.
Our study revealed higher incidence rates of PICC-related complications in adult patients with haematological malignancies compared to the finding of other studies. Notably, patients with underlying acute leukaemia displayed a higher incidence of PICC-related infections. These findings underscore the importance of implementing appropriate interventions and conducting thorough root cause analyses to effectively mitigate this complication and improve patient outcomes.
由于血液系统恶性肿瘤患者需要长期静脉治疗，外周静脉穿刺中心静脉导管（PICC）在这类患者中被广泛使用。然而，PICC使用的增多导致了多种并发症，如感染和血栓形成，进而导致住院时间延长和发病率增加。本研究旨在确定血液系统恶性肿瘤患者中PICC相关并发症的发生率及相关因素。
本前瞻性队列研究在一家学术机构进行。纳入标准包括所有新置入PICC的成年血液系统恶性肿瘤患者。对患者进行至少60天的观察，以评估PICC相关感染、血栓形成以及机械性并发症的发生率。
85例患者共置入119根PICC。其中，超过一半的患者被诊断为淋巴瘤（55.0%）。中位留置时间为61天（四分位间距：98天）。PICC相关并发症的发生率为58.0%（每1000导管日6.9例）。具体而言，43根PICC（36.1%，每1000导管日4.3例）发生感染性并发症，25根（21.1%，每1000导管日2.5例）出现机械性并发症，1根（0.8%，每1000导管日0.1例）出现血栓性并发症。此外，急性白血病的潜在诊断与PICC相关感染的较高发生率显著相关。
我们的研究显示，与其他研究结果相比，成年血液系统恶性肿瘤患者中PICC相关并发症的发生率更高。值得注意的是，潜在急性白血病患者的PICC相关感染发生率更高。这些发现强调了实施适当干预措施并进行全面根本原因分析以有效减轻这种并发症并改善患者结局的重要性。
