Research On The Development And Related Factors For PICC Related Thrombosis In Cancer Patients

ObjectiveTo investigate the time of thrombosis,the incidence in different time periods, clinical symptom, related factors of catheter-related thrombosis(CRT) associated with peripherally inserted central catheter(PICC) through the prospective investigation of cancer Patients. Provide a reference for the prevention and treatment of PICC-related thrombosis.MethodsFrom May 2014 to April 2015, we select cancer patients with PICC in the oncology department of our affiliated hospital, according to the inclusion and exclusion criteria to determine the object of study. We collect and record the patient,s general characteristics, diagnosis and treatment of disease, catheterization,complications, etc.Patients were followed up from the PICC catheter until extubation or at least six courses of chemotherapy. Researcher measure blood flow velocity and vessel diameter above the elbow 10cm and examine PICC-related thrombosis after the catheter within 24h using doppler ultrasound. Patients were followed up in the catheter after 5-7d^ 9-14d and every chemotherapy using Doppler ultrasound. Using SPSS 13.0 statistical software, survival analysis using Kaplan-Meier method,Univariate analysis by Log-rank test and multivariate prognostic analyzes using Cox proportional hazards model, the use of Forward the LR method to filter the variable.Results1.308 cancer Patients were studied in our research. Of these 263 patients were complete data.41.44% were found to have PICC-related thrombosis.22.96% of PICC-related thrombosis occurs after the end of the first chemotherapy, to the sixth chemotherapy was 45.65%. The cumulative proportion of PICC-related thrombosis is increased.2. The median time to thrombosis is the first 15 days. The first PICC-related thrombosis occurs after 24h and the latest occurred after catheter 127d.2.75%(3/109) of patients occurs after catheterization 24h and 45.87%(50/109) occurs in the first one cycle of chemotherapy.9.17%(10/109) of patients occurs in the 1st intermittent chemotherapy,16.51%(18/109) of patients in the 2nd chemotherapy. Number of thrombosis occurred 3,4,5,6 chemotherapy patients were 8.26% (9/109),9.17%(10/109),5.50%(6/109),2.75%(3/109).3.29.36%(32/109) of patients with complete thrombosis,22.02%(24/109) for deep vein thrombosis,23.85%(26/109) for symptomatic PICC-related thrombosis.73.08 (19/26) of patients with swelling,26.92%(7/26) of patients with limb pain or pain, 53.85%(14/26) of patients with venous inflammatory conditions.4.The results of univariate analyzes about PICC-related thrombosis:Multivariate analysis showed that:ECOG, Chemotherapy history, PICC catheter ipsilateral history, Catheter way, Tip position, Blood flow velocity, History of thrombosis, median vein or cephalic vein puncture are related factor of PICC-related thrombosis.Conclusion1.PICC-related thrombosis is high incidence in cancer with PICC, and more without thrombus-related symptoms. In order to early detection and treatment of PICC-related thrombosis, the use of doppler ultrasonic scanner for PICC catheter in patients with follow-up is necessary.2.PICC-related thrombosis occurs mainly in the first period of chemotherapy.To reduce the incidence of CRT, the medical staff should actively carry out preventive PICC-related thrombosis’s knowledge in the early.3.To reduce the vascular damage, B ultrasound-guided catheter should actively be undertaken. In order to reduce unnecessary extubation and the number of catheter, we should establish guidelines for PICC catheter. If you want to re-catheterization, contralateral vessel should be selected. Reduce the incidence of PICC-related thrombosis and improve the efficiency of PICC.