Skip to search form Skip to main content. This study aims looking at the incidence of PICC line related and distant thromboembolism associated with these catheters and exploring risk factors. MethodsRecords were reviewed for patients who underwent PICC line insertion over the two years period in the medical oncology unit, Milton Keynes University Hospital. View on Springer. Open Access.
Recent Activity. A regression model Factors predictive of pick line insertion done which examined the association between renal function and thrombosis after adjusting for transplant the only factor in the study that was significantly associated with thrombosis but not with renal Facctors. J Clin Nurs. The importance of lumen size was further highlighted in a follow-on study [ 27 ]. From the results in our study, we saw that over half Future lf trials are needed to validate our findings and confirm the type of catheter recommended for high risk patient sub-groups. A total of 17 variables were entered by univariable logistic regression analyses, including, sex, age, complications, operation history, smoking history, activity amount, obesity, oral anticoagulants, chemotherapy history, vein of PICC, puncture position of PICC, PICC adjustment, side of PICC, number of punctures, catheter tip position, PICC brand, and puncture method. A prospective study 7 showed a Our data matched the previous published literature regarding thrombosis rate insertio PICCs [ 481415 ]. Skip to search form Skip to Escorted tour europe cheap content.
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Peripherally inserted central venous catheters PICCs are commonly placed but limit sites for fistula creation in patients with chronic renal failure CKD. This investigation identifies populations of patients who may not be ideal candidates for a PICC and highlights the importance of peripheral vein preservation in patients with renal failure.
Materials and methods: A venous Doppler ultrasound was performed at the time of SBIJ insertion and removal to evaluate for thrombosis in the internal jugular vein. Data was collected pre- and post-intervention to ascertain if increased vein preservation knowledge amongst the healthcare team led to less use of PICCs. One patient with an SBIJ had evidence of central vein thrombosis when the catheter was removed.
Conclusions: There are subsets of patients with high risk for thrombosis who may not be ideal candidates for a PICC. When compared to central venous catheters, complications with fistulas and grafts are much lower [ 1 , 2 ]. However, the success of a fistula or graft is dependent on underlying preservation of central and peripheral veins prior to the patient starting on dialysis. Obstacles to venous access placement include previous damage from phlebotomy, and peripherally inserted central catheters PICCs.
A PICC is a catheter placed in a peripheral cephalic or basilic vein used to deliver chemotherapy, antibiotics or total parenteral nutrition TPN. They are often left in place for weeks or months. Given the relative ease of insertion, PICCs have become commonplace in hospitals across the country [ 3 , 4 ]. Although PICC lines are considered safe with a low incidence of complications, placement can result in phlebitis, stenosis or thrombosis of the involved veins [ 5 , 6 ]. Previous studies have shown that the risk of PICC associated deep venous thrombosis is comparable to rates seen in individuals with hypercoagulable states [ 7 ].
Additional factors leading to increased rates of thrombosis include: catheter diameter, history of previous thromboembolism, renal failure, and surgery for longer than 1 hour [ 8 , 9 ]. Once the vein is damaged, sclerosis may result and prevent future use of the vein for hemodialysis fistula access. Instead, a small bore internal jugular catheter SBIJ is the preferred access in this subgroup of patients [ 11 , 12 ].
However, the thrombosis rate after placement of such small-bore catheters has never been prospectively reviewed. A secondary aim is to determine if variables such as renal function, diabetes, hypertension, cancer, transplant or a history of atherosclerosis contribute to the risk of thrombosis when PICCs are placed. To our knowledge, these data provide the first evidence of the incidence of thrombotic complications from placement of an SBIJ venous access. The study was conducted at a single, large, university-based medical center from September 1, through December 31, This study was submitted to, and approved by the Institutional Review Board at the University of Chicago Protocol A with adherence to the Declaration of Helsinki.
Written consent was obtained in all subjects undergoing SBIJ access placement. If the patient required IV access with a central venous catheter and met one of the aforementioned criteria without a contra-indication for central venous access, the Nephrologist would advise the primary service to order an SBIJ to be placed by Interventional Radiology in substitution for a PICC access. Contraindications to enrollment in the study included anti-coagulation which could not be reversed i.
Written consent was obtained prior to catheter access by Interventional Radiology. SBIJ placement was performed solely by an Interventional Radiologist with either a single lumen 5 French or double lumen 6 French small bore catheter C. Bard, Inc. At time of placement, a real time Doppler ultrasound image of the IJV was taken to determine patency, vein dimensions, and ensure the vessel was free of stenosis and thrombosis.
A guide wire was advanced into the SVC under fluoroscopic guidance. Using blunt dissection, a subcutaneous tunnel was created to allow placement of the catheter. Spot thoracic radiographs were performed to ensure the tip of the catheter was in the right atrium or superior vena cava.
The catheter was flushed with saline and secured to the skin with non-absorbable suture. Once it was time for catheter removal, patients again returned to Interventional Radiology and underwent an ultrasound to evaluate for presence of thrombus and measure vein diameter just prior to removal. PICC data was gathered by conducting a chart review from September 1, through December 31, Patients who received a PICC during the study period were determined by reviewing procedure log billing sheets.
A separate IRB was generated for this portion of data collection with waived consent Protocol with adherence to the Declaration of Helsinki. Patient demographics and past history including diabetes, hypertension, peripheral vascular disease PVD , coronary artery disease CAD , transplant, history of cancer, and CKD were obtained from paper and electronic medical records for all patients included in the study.
A patient was considered to have CAD if they had a prior history of myocardial infarction or cardiac catheterization performed showing significant coronary disease. A patient was considered to have PVD if they had a prior history of amputation from ischemic disease or a vascular study showing ankle-brachial index less than 0. A patient was counted as a transplant if they had received a hematopoietic or solid organ transplant.
Indications for venous access and duration of catheter were recorded. If a patient had a thrombotic event evident on Venous Duplex it was counted as a central occlusion if thrombosis was evident in the internal jugular, brachiocephalic, subclavian or axillary vein; peripheral if thrombosis was evident in the cephalic, basilica, or brachial vein; or both if the thrombosis was evident in the central and peripheral veins. If a patient had a CT of the chest done and there was evidence of central vein thrombus or a pulmonary emboli, it was counted as a central thrombotic event.
If a patient had an echocardiography done and a right atrial thrombus was evident, it was counted as central thrombotic event. Patient age, BMI, and duration days associated with first catheter placement were summarized by mean and standard deviation. Logistic regression models of overall thrombosis status were adjusted for variable values at time of first catheter placement. Generalized estimating equations GEE were used to fit logistic regression models of all thrombosis outcome that were adjusted for covariate values in all PICC placements evaluated for a single patient.
Each model included at least one variable shown to be related to thrombosis and excluded correlated variables identified in pairwise analyses. All statistical analyses were performed in R version 3. There were PICC lines placed during the study period in 1, subjects. Table 1 details the clinical characteristics of those individuals with or without thrombosis incidence recorded for any PICC placed.
All groups had relatively similar age, proportion of male subjects, and average BMI. There were only In particular, patients whose underlying medical conditions merited the need for total parenteral nutrition TPN were more likely to experience thrombosis events whereas those who needed antibiotics had a lower risk of thrombosis.
There were 21 subjects with a transplant who developed thrombosis after a PICC placement. A right IJ catheter was placed in 25 subjects, a left catheter in 1 subject. A single lumen catheter was placed in 4 subjects and a double lumen catheter was placed in 22 subjects. The patient had a BMI of Analysis of pairwise relationships between covariates revealed evidence of significant correlation between indication and transplant status.
Thus, we considered separate models of thrombosis status that included either transplant or indication as a covariate. Relative to antibiotics, patients with an indication of chemotherapy, other, and TPN were at higher risk of thrombosis than those whose indication was for antibiotics Table 3.
The increased risk for subjects with immunosuppression indication was not significant. Subjects who received a transplant were also at a significantly higher risk Table 4. Findings in the GEE analysis were similar to univariate and multivariate analysis, as indication of TPN, other and chemotherapy were significant. In the GEE model, CAD was found to be a significant risk factor for thrombosis; however, there was no evidence of a significant relationship between transplant and thrombosis risk.
A regression model was done which examined the association between renal function and thrombosis after adjusting for transplant the only factor in the study that was significantly associated with thrombosis but not with renal function.
Of these Thrombotic complications are common after PICC placement. Our data matched the previous published literature regarding thrombosis rate from PICCs [ 4 , 8 , 14 , 15 ]. The thrombotic rate, as measured by thrombus evident at time of catheter removal, was minimal in patients with renal failure who received an SBIJ. Patients with a transplant had a higher risk of thrombosis in our series. Most of these subjects had a recent stem cell transplant.
Others have shown a higher rate of complications including infection and thrombosis in onco-hematological patients [ 17 ]. Chemotherapy has also been shown to increase the risk of venous thrombosis and may have been a contributing factor in this patient group [ 18 ].
TPN has been identified as a risk factor for venous thrombosis in previous studies [ 9 ]. Risk factors that predispose to central venous catheter-associated thromboses have been identified in multiple studies in the past. It has been shown that an increased diameter of the catheter used is associated with an increased risk of thrombosis [ 6 ].
Another less commonly cited factor is the position of the catheter tip. Previous studies have shown a higher risk of thrombosis for central venous catheters terminating in the brachiocephalic vein or cranial superior vena cava when compared to those placed at the appropriate position as above [ 19 ].
The duration of the catheter placement has also been shown to be associated with an increased risk of thrombosis [ 20 ]. The number of lumens in the catheter dual vs. Given the retrospective nature of data collection in the PICC group in our study, we were not able to identify some of these important technical properties and exact location of the PICC placed.
Efforts to prevent PICCs in patients with renal failure and transplant should be made as they lead to sclerosis of the peripheral vein, preventing use for hemodialysis in the future [ 12 ]. There are only two superficial venous systems in each arm, the cephalic and the basilic. PICCs are often inserted into the basilic system. Vein injury anywhere along the length of the catheter, is considered a primary initiating event for catheter-related thrombosis which may make the entire extremity useless for future placement of an AVF [ 21 , 22 ].
Furthermore, associated thrombi pose problems both in terms of short term management of line dysfunction due to the clot, and if not detected early, may eventually lead to propagation of the clot to the catheter tip or into the peripheral vein [ 23 ].
Of these, many were placed in patients with CKD. By changing practice notifying the procedure service of the need to prevent PICC placement in this high risk population , we decreased PICC placement from There are a number of key limitations to our study. Among these is the small sample size of patients who received SBIJ catheters. As the short term risk of thrombosis was shown to be minimal and we had changed practice patterns, this arm of the study was terminated early.
Another limitation is that the study did not account for inherited hyper-coagulable states in either group, a factor that may confound the results. A significant portion of subjects were lost to follow up or had incomplete medical records, though all attempts were made to ensure a complete database. A thrombotic event, was determined from a retrospective review of imaging procedures that diagnosed a thrombotic event.
Home How can we help you today? Back to Being treated with chemotherapy. Fill in your details below or click an icon to log in:. How chemotherapy is given Chemotherapy can be given in different ways depending on the type of cancer you have and your treatment plan. Also operating in Northern Ireland.
Factors predictive of pick line insertion. Elements of PI
Caby decided to pursue her PICC certification after watching a co-worker. The researchers found that Este estudo tem como objetivo analisar o conhecimento dos enfermeiros quanto a utilizacao do PICC na pratica assistencial, em tres hospitais publicos da regiao litoranea do Estado do Rio de Janeiro.
Methods: Two hundred patients treated with PICC catheterization from January to December were selected and randomly divided into two groups, namely, observation group and control group. Clinical effect of peripherally inserted central catheters based on modified seldinger technique under guidance of vascular ultrasound.
Among these, hospitals account for the largest revenue share of the market, owing to increasing number of PICC insertion procedures carried out in hospitals. The sky is the limit.. Customers tell us they love the look and feel of the fabrics and are more comfortable going out in public with their PICC Line securely covered," Nakashima said. It is used to give you chemotherapy and other medicines. A doctor or nurse puts it into a vein above the bend of your elbow.
It can stay in place until your treatment is over. You will be given a local anaesthetic to numb the area before the PICC line is put in.
Your doctor or nurse will gently thread the line along the vein in your arm until it is in a large vein in your chest. You will have an x-ray to check it is in the correct position.
The PICC line is held in place by a dressing, which is usually changed every week. The cap at the end of the line is replaced each week to reduce the risk of infection.
The line is flushed regularly to prevent it becoming blocked. Contact your hospital doctor or nurse if you have any swelling, pain or leaking fluid around the PICC line. Also tell them if you do not feel well. When you no longer need the PICC line, it will be taken out. Show more. A PICC line peripherally inserted central catheter line is used to give someone chemotherapy treatment or other medicines.
A PICC line is a long, thin, hollow, flexible tube called a catheter. It is put into one of the large veins of the arm, above the bend of the elbow. Then it is threaded into the vein until the tip is in a large vein just above the heart.
The line is usually sealed with a special cap or bung. This can be attached to a drip or syringe containing your chemotherapy or medication. There may be a clamp to keep the line closed when it is not being used. Sometimes it divides into 2 or 3 lines. This allows you to have different treatments at the same time. Read a description of this image. If you have a PICC line, you will not need to have needles put in every time you have treatment. This can be helpful if doctors and nurses find it difficult to get needles into your veins.
It is also helpful if you do not like needles. About our cancer information videos. A specialist nurse or doctor will put in your PICC line at the hospital. It can either be done in an outpatient department or on a ward. They will talk with you about which arm would be better to use. Your doctor or nurse may use an ultrasound scan to help them find the best vein to use in your arm.
The ultrasound uses sound-waves to produce a picture of the veins in your arm. A small hand-held device is rubbed gently over your arm. This is painless.
Then the skin in the area where the line will be put in is cleaned with antiseptic solution. This area is numbed with an anaesthetic cream or injection.
When the skin is completely numb, a needle is put into the vein. The PICC line is threaded through the needle into a large vein that leads to the heart. The needle is removed at the same time. This should not take long and is usually painless. The PICC line will be held in place by a clear dressing.
Sometimes, it can be difficult to thread the PICC line up the vein towards the heart. If this happens, it is usually possible to try again using a different vein. Sometimes, the PICC line seems to go in easily but the x-ray shows it is not in the right place. If this happens, your nurse or doctor may be able to move it. If that does not work, the PICC line will be taken out and replaced.
When the PICC line is not being used, there is a slight risk of it becoming blocked. To stop this from happening, a small amount of fluid is flushed into the line using a syringe. This is usually done once a week. The caps or bungs at the end of the line need to be changed each week to reduce the risk of infection.
The dressing also needs to be changed every week. If it gets wet or starts to peel off, it should be changed sooner. It is difficult to change the dressing with one hand, so the nurses at the hospital may do it for you or arrange for a district nurse to visit you at home. They can also teach a family member, partner or friend how to change the dressing. When you are at home, it is safe for you to have a shower or bath with your PICC line in.
Your nurse can give you waterproof covers to stop the line getting wet. Infection It is possible for an infection to develop inside the PICC line or in the area where it goes into the vein. If you get an infection, you will be given antibiotics. If the infection does not get better, the line may be removed. It is possible for a blood clot thrombosis to form in your vein at the end of the line. You may be given medication to help prevent this. Contact your hospital doctor or nurse if you have:.
If a clot does form, you will be given some medication to dissolve it. Your line may have to be removed. If this happens, it can be difficult to give treatment or to take blood tests through it.
The line may be flushed with a solution to try to clear the blockage, or it may need to be removed. It is important not to get any air into your PICC line. Not all PICC lines have clamps. Some lines have caps at the end that stop air from getting into the line. If your PICC line has a clamp, it should always be closed when the line is not being used.
The line must not be left unclamped when the caps are not in place. To stop the line coming out by accident, it should always be taped or covered with a dressing. If the dressing holding the PICC line in place comes loose, tell your district nurse or hospital nurse straight away.
Then it can be replaced as soon as possible. It is not very common to get a cut or split in the line. If this happens, try to clamp or tie your line just above the break. This is to seal it between the split and where the line comes out of your body. Contact your hospital straight away. The line may need to be removed if it cannot be repaired.
A slide show with tips for avoiding infection during chemotherapy. Chemotherapy reduces your immunity. When you do not need a PICC line any more, it will be taken out. A nurse will usually do this for you in an outpatient department. The line will be gently pulled out, and the area where the PICC line was put in will be covered with a dressing.
Skip to search form Skip to main content. This study aims looking at the incidence of PICC line related and distant thromboembolism associated with these catheters and exploring risk factors. MethodsRecords were reviewed for patients who underwent PICC line insertion over the two years period in the medical oncology unit, Milton Keynes University Hospital.
View on Springer. Open Access. Save to Library. Create Alert. Share This Paper. Figures, Tables, and Topics from this paper. Figures and Tables. Citations Publications citing this paper. References Publications referenced by this paper.
Risk factors for catheter-related thrombosis CRT in cancer patients: a patient-level data IPD meta-analysis of clinical trials and prospective studies. W Saber. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. Melina Verso , Giancarlo Agnelli. John P. Winters , Peter W. Callas , Mary Cushman , Allen B. Repp , Neil A.
Flanders , Vineet Chopra. A systematic review of the pathophysiology of 5-fluorouracilinduced cardiotoxicity. A Polk. Anticoagulation for people with cancer and central venous catheters. Elie A. Akl , Elie P. Focus on peripherally inserted central catheters in critically ill patients. Paolo Cotogni , Mauro Pittiruti.
Peripherally inserted central catheter thrombosis--reverse tapered versus nontapered catheters: a randomized controlled study.