Department Nursing Specialized in Vascular Access, RN, MD. Hospital Sírio Libanês, São Paulo, São Paulo, Brazil.
Adjunct Professor at the Federal University of Viçosa, RN, PhD. Viçosa, Minas Gerais, Brazil.
PLoS One. 2024 May 6;19(5):e0300425. doi: 10.1371/journal.pone.0300425. eCollection 2024.
Deep Venous Thrombosis (DVT) due to Peripherally Inserted Central Catheter (PICC) is one of the most threatening complications after device insertion.
To assess the rate of PICC-associated DVT and analyze the risk factors associated with this event in cancer and critically ill patients.
We conducted a descriptive, retrospective cohort study with 11,588 PICCs from December 2014 to December 2019. Patients ≥ 18 years receiving a PICC were included. Pre-and post-puncture variables were collected and a logistic regression was used to identify the independent factors associated with the risk of DVT.
The DVT prevalence was 1.8% (n = 213). The median length of PICC use was 15.3 days. The median age was 75 years (18; 107) and 52% were men, 53.5% were critically ill and 29.1% oncological patients. The most common indications for PICC's were intravenous antibiotics (79.1%). Notably, 91.5% of PICC showed a catheter-to-vein ratio of no more than 33%. The tip location method with intracavitary electrocardiogram was used in 43%. Most catheters (67.9%) were electively removed at the end of intravenous therapy. After adjusting for cancer profile ou chemotherapy, regression anaysis revealed that age (OR 1.011; 95% CI 1.002-1.020), previous DVT (OR 1.96; 95% CI 1.12-3.44) and obstruction of the device (OR 1.60; 95% CI 1.05-2.42) were independent factors associated with PICC-associated DVT, whereas the use of an anticoagulant regimen was a protective variable (OR 0.73; 95% CI 0.54-0.99).
PICC is a safe and suitable intravenous device for medium and long-term therapy, with low rates of DVT even in a cohort of critically ill and cancer patients.
外周静脉置入中心静脉导管（PICC）相关的深静脉血栓（DVT）是置管后最具威胁性的并发症之一。
评估 PICC 相关 DVT 的发生率，并分析癌症和重症患者中与该事件相关的危险因素。
我们进行了一项描述性、回顾性队列研究，纳入了 2014 年 12 月至 2019 年 12 月期间的 11588 例 PICC。纳入接受 PICC 的年龄≥18 岁的患者。收集置管前后的变量，并采用逻辑回归分析确定与 DVT 风险相关的独立因素。
DVT 的患病率为 1.8%（n=213）。PICC 使用的中位时间为 15.3 天。中位年龄为 75 岁（18-107 岁），52%为男性，53.5%为重症患者，29.1%为癌症患者。PICC 最常见的适应证为静脉内抗生素（79.1%）。值得注意的是，91.5%的 PICC 导管-静脉比不超过 33%。腔内心电图引导的尖端定位方法使用率为 43%。大多数导管（67.9%）在静脉治疗结束时选择性拔出。在调整癌症特征或化疗后，回归分析显示，年龄（OR 1.011；95%CI 1.002-1.020）、既往 DVT（OR 1.96；95%CI 1.12-3.44）和导管阻塞（OR 1.60；95%CI 1.05-2.42）是与 PICC 相关 DVT 相关的独立因素，而抗凝方案的使用是保护变量（OR 0.73；95%CI 0.54-0.99）。
PICC 是一种安全且适合中、长期治疗的静脉装置，即使在重症和癌症患者中，DVT 的发生率也较低。
