Upper-extremity PICC associated venous thrombosis

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Upper-extremity venous thrombosis is associated with the use of peripherally inserted central catheters (PICCs). Few pediatric studies have focused on this issue” Menéndez Suso et al (2016).

Abstract:

BACKGROUND: Upper-extremity venous thrombosis is associated with the use of peripherally inserted central catheters (PICCs). Few pediatric studies have focused on this issue.

OBJECTIVES: To determine the incidence and risk factors for PICC-related superficial (SVT) and deep venous thrombosis (DVT) in children.

PATIENTS/METHODS: Observational follow-up cohort study conducted at a single hospital between June 2012 and June 2015. All patients receiving a PICC were enrolled and followed-up, conducting weekly Doppler-ultrasound examination of the catheterized limb until PICC removal. Patient, procedural and follow-up data were analyzed.

RESULTS: In the study period, 265 PICCs were inserted [median age 6.5 years (IQR 2.4-13); median weight 20 Kg (IQR 11-38); 54% males; 67.9% chronically ill], and followed-up for a total of 9743 days. Median indwelling time was 21 (IQR 12-37) days. In the follow-up, 88 (33.2% of insertions) PICC-related thrombosis (IR 9.03 per 1000 catheter-days) were diagnosed, 66 (24.9%) as isolated SVT, 7 (2.6%) as isolated DVT, and 15 (5.7%) as SVT with associated DVT (IR 6.78, 0.71 and 1.54 per 1000 catheter-days, respectively). Only 9.9% of the patients with SVT and 18.2% with DVT were symptomatic. The main risk factors for PICC-related SVT and DVT were a catheter to vein ratio > 0.33 and the thrombosis of the catheterized superficial vein, respectively.

CONCLUSIONS: PICC-related thrombosis is a common and nearly always asymptomatic complication in children, being SVT rate about three times higher than that of DVT. Optimal vein and catheter selection, yielding the lower possible catheter to vein ratio, may decrease PICC-related thrombosis.

Reference:

Menéndez Suso, J.J., Verdú Sánchez, C., Calderón Llopis, B., Gómez Zamora, A., Schüffelmann Gutiérrez, C., de la Cruz Troca, J.J. and de la Oliva Senovilla, P. (2016) Incidence and risk factors of superficial and deep venous thrombosis associated with peripherally inserted central catheters in children. Journal of Thrombosis and Haemostasis. August 25th. [Epub ahead of print].

doi: 10.1111/jth.13478.

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