Although generally regarded safe, infections and thrombotic events have occurred with PICC use, necessitating study to guide future clinical prophylaxis and management” McAuliffe et al (2016).
INTRODUCTION: Peripherally inserted central catheters (PICC) have been increasingly used for administration of chemotherapy, antibiotics and blood products in patients with haematological malignancies. Although generally regarded safe, infections and thrombotic events have occurred with PICC use, necessitating study to guide future clinical prophylaxis and management.
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AIM: 1) Determine the incidence of PICC associated thrombosis in patients with haematological malignancies 2) To identify clinically significant risk factors contributing to these complications.
MATERIALS AND METHODS: This was a cohort study, conducted in Cork University Hospital, between January 2010 and June 2015. After ethical approval Picture Archiving and Communication System (PACS) in radiology was used. All adult patients with PICC inserted under haematology were identified. A total of 90 patients with haematological malignancies who had PICC line placement were included. Patients’ charts were reviewed in the medical record department. Data was collected using proforma sheets. This included patients demographs, type of malignancy, size of the PICC line, and total days of insertion. Haematological laboratory parameters were also recorded. The main outcome measures were PICC associated thrombosis and/or infection
RESULTS: Of 131 PICC placements in a total of 90 patients. Out of these total PICC episodes 28.2% developed complications (n=37) and lead to removal. Thrombosis was found in 14.5% (n=19), 13.7% developed infection (n=18) and remaining were without complications. Of those with thrombosis (n=19), 7 patients had a diagnosis of Multiple Myeloma and 6 had Acute Myeloid Leukaemia. Whereas those with PICC associated infection (n=18), 5 had Non-Hodgkin’s lymphoma and 5 had Acute Lymphoid Leukaemia. Diagnosis was significantly associated with complication (p=0.019). The mean age of patients who has PICC associated thrombosis was 51.6 years (±8.1 years). PICC removal as a result of complications was associated with increasing PICC lumen size; 30% of 5-French PICCs necessitated removal whereas 79.2% of 6-French PICCs necessitated removal (p=0.01). In addition, increased PICC lumen size was associated with clinically evident thrombophlebitis; 30% of 5-French PICCs displayed thrombophlebitis vs. 77%of 6-French PICCs displayed thrombophlebitis (p=0.017). Decreased in PICC lumen size was shown to influence the risk of complications; of 5 French catheters, 20% had thrombosis and 15% had infection, vs. 6 French catheters (13% and 13% respectively). Men were found to experience complications earlier with 80% of men having complications 1-50 days post PICC insertion and 12% 51-100 days post insertion.
CONCLUSIONS: The risk of complications of PICC line insertion is relatively high in patients with haematological malignancies. Our institute thrombosis rate is similar to other studies. Haematological diagnosis was significantly associated with complication risk. Increased PICC lumen size was associated with higher removal rates as a result of complications and clinical signs of thrombophlebitis.
McAuliffe, E., O’Shea, S. and Khan, M.I. (2016) PO-02 – Retrospective audit of the Peripherally Inserted Central Catheter (PICC) associated thrombosis in patients with haematological malignancies at Cork University Hospital. Thrombosis Research. 140(Suppl 1). p.S176.
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