Li Nick, Njoku Paul, Mandal Amit K J, El Kafsi Jihène, Hosack Tom, Stockdale Thomas, Dassanayake Sohani, Van den Abbeele Koenraad, Democratis Jane, Missouris Constantinos G
Surgery, The Queen's College, University of Oxford, Oxford, GBR.
Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, GBR.
Cureus. 2024 Dec 8;16(12):e75325. doi: 10.7759/cureus.75325. eCollection 2024 Dec.
Introduction Surgical inpatients frequently require peripherally inserted central catheters (PICCs) for parenteral feeding and administration of medication. PICCs may cause upper limb deep venous thrombosis (ULDVT), which impacts patient morbidity. We investigated the risk and prevention of PICC-ULDVT in hospitalised surgical inpatients. Methods We conducted a retrospective analysis of 168 consecutive surgical inpatients who received a PICC over the same four-year period. Data from 136 additional consecutive general medical inpatients with PICCs over the same period were included for comparison. We observed and compared the incidence of ULDVT confirmed on dedicated upper limb venous imaging in the cohort of surgical patients compared to a time matched cohort of medical patients. We extracted data including patient demographics, details of admission, and insertion site of the PICC from the hospital electronic notes. Results The incidence of ULDVT in surgical patients was 4.7% compared to 1.5% in medical patients despite increased age (p=0.001) and comorbidity burden (p=0.001) in the latter group. Ninety percent of surgical patients had abdominal surgery within 30 days of PICC placement. Regression multivariate analysis identified concurrent cancer (p=0.048), median Charlson Comorbidity Index (CCI) (p=0.034), admission with malignant bowel obstruction (p=0.002), and catheter insertion into the brachial vein (p=0.033) as significant risk factors for PICC-ULDVT in hospitalised surgical patients. Standard pharmacological venous thromboembolic events (VTE) prophylaxis, as per national guidelines, did not reduce the risk of PICC-ULDVT. Conclusion Our study indicates that surgical inpatients are at greater risk of developing PICC-associated upper limb deep vein thrombosis (ULDVT) compared to medical inpatients, with limited evidence supporting the effectiveness of pharmacological thromboprophylaxis in reducing this risk. PICCs should be used with caution in patients with cancer, cancer-related bowel obstruction, and surgical patients with a higher comorbidity index. PICCs inserted via the basilic vein may reduce ULDVT risk, but further studies are needed on the preferential site of insertion in surgical patients.
引言 外科住院患者经常需要经外周静脉穿刺中心静脉置管（PICC）来进行肠外营养和药物输注。PICC可能会导致上肢深静脉血栓形成（ULDVT），这会影响患者的发病率。我们调查了住院外科患者中PICC-ULDVT的风险及预防措施。
方法 我们对在同一四年期间接受PICC的168例连续外科住院患者进行了回顾性分析。同期另外136例连续接受PICC的普通内科住院患者的数据也被纳入以作比较。我们观察并比较了外科患者队列中经专门的上肢静脉成像确诊的ULDVT发生率与同期内科患者的匹配队列。我们从医院电子病历中提取了包括患者人口统计学资料、入院详情以及PICC置管部位等数据。
结果 外科患者中ULDVT的发生率为4.7%，而内科患者为1.5%，尽管内科患者年龄更大（p=0.001）且合并症负担更重（p=0.001）。90%的外科患者在PICC置管后30天内进行了腹部手术。多因素回归分析确定，合并癌症（p=0.048）、Charlson合并症指数中位数（CCI）（p=0.034）、因恶性肠梗阻入院（p=0.002）以及导管插入肱静脉（p=0.033）是住院外科患者发生PICC-ULDVT的显著危险因素。按照国家指南进行的标准药物性静脉血栓栓塞事件（VTE）预防措施并不能降低PICC-ULDVT的风险。
结论 我们的研究表明，与内科住院患者相比，外科住院患者发生PICC相关上肢深静脉血栓形成（ULDVT）的风险更高，且仅有有限的证据支持药物性血栓预防措施在降低此风险方面的有效性。对于癌症患者、癌症相关肠梗阻患者以及合并症指数较高的外科患者，应谨慎使用PICC。经贵要静脉插入PICC可能会降低ULDVT风险，但对于外科患者的优先置管部位还需要进一步研究。
