Tumor Patients With Picc-related Upper Extremity Venous Thrombosis And Its Risk Factors

Objective:To investigate the incidence and average happening time of upper extremity vein thrombosis associated with peripherally inserted central catheter (PICC) through the prospective investigation of cancer patients with PICCs.To determine the risk factors of PICC related upper extremity vein thrombosis with the aim of providing evidence for clinical intervention to decrease the incidence of PICC related thrombosis.Methods:From May to December,2009, we prospectively investigated the cancer patients who had their PICCs in the PN & EN department of Peking Union Medical College Hospital. We collected all the patients who met the admission criteria of our study. We followed up these patients for one month prospectively, and recorded the information when they had their PICCs insertion and their general information. Every week we checked their upper extremity with PICC using Doppler color ultrasound and recorded the examination results and the patients'other associated conditions. The differences in the incidence of thrombosis between different groups were examined for statistical significance with chi-square and logistic regression analysis was applied for identification of the risk factors of PICC related thrombosis.Results:According to the selected criteria,125 cancer patients were studied in our research. Of these,101 patients were followed up for at least one month. At the end of the month after PICC insertion,50.5% were found to have thrombosis.The incidence of the I class thrombosis which only changed blood stream was 24.8%;the incidence of the II class which blocked part of the blood vascular was 12.9%; the one of the III class which almost blocked the whole blood vascular was'12.9%.The average happening time of PICC related upper extremity vein thrombosis was 11.80±7.206 day. Of the 101 cancer patients,23(22.8%)had phlebitis or thrombosis symptom and 6 cases of them suffered from severe upper extremity swelling, covering 11.8% of the ones who had PICC related thrombosis.Multi-factor logistic regression analysis showed that the risk factors of upper extremity vein thrombosis associated with PICC were less amount of physical activity (OR=32.251) and obesity (OR=5.063). The risk factors of the II class and the III class thrombosis were wound history (OR=14.370), less amount of physical activity (OR=2.687), obesity (OR=6.233), low hemoglobin (OR=4.575),shorter activated partial thromboplastin time (APTT) (OR=4.408), higher thrombinogen activity (PT%) (OR=12.327) and high fibrinogen (Fbg) (OR=8.246) by multi-factor logistic regression analysis. The risk factors of the III class, fully blocking thrombosis included:wound history (OR=44.136),less activity amount(OR=9.262),central venous catheter(CVC) insertion history(OR=12.225),obesity(OR=7.094), different puncture methods (OR=0.023) and high Fbg(OR=7.718).Conclusion:Our results suggest that:①Less activity amount and obesity are risk factors of upper extremity vein thrombosis associated with PICCs.②It is very necessary to prevent ahead the happening of the upper extremity vein thrombosis associated with PICCs in the first month after PICC insertion.③The incidence of upper extremity vein thrombosis associated with PICCs is relatively high, most of which is symptomless. We should pay more attention to this kind of thrombosis.