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Wu XH, Xiao Y, Tian RD. The association between ABO blood types and peripherally inserted central catheter-related venous thrombosis for patients with cancer: A retrospective 7-year single-center experience and meta-analysis. PLoS One 2024; 19:e0305746. [PMID: 38950056 PMCID: PMC11216569 DOI: 10.1371/journal.pone.0305746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/04/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND This meta-analysis evaluated the association of ABO blood type on central venous catheter-related thrombosis (CRT). METHODS Data were derived from 8477 patients at Sichuan Cancer Hospital from January 2015 to December 2021 and articles previously published in Chinese and English databases. Data from our hospital were collected by reviewing electronic medical records. Searched databases included CNKI, VIP, Wan Fang, China Biomedical, PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, and OVID (up to July 2023). All statistical analyses were performed using SPSS 22.0 and Revman 5.3. The Bonferroni method was used to adjust the α test level for reducing the risk of I errors in the multiple comparisons. A P-value < 0.05 was considered statistically significant. Continuous variables were analyzed using a two-independent sample T test. The chi-squared test was used to analyze categorical data. RESULTS A total of 818 studies were identified in the search. However, only four studies met the inclusion criteria. Combined with data from our hospital, five studies were included with a total of 18407 cases. Those studies only focused on peripherally inserted central catheter (PICC). According to the data from our hospital, logistic regression revealed that myelosuppression [odds ratio (OR), 1.473; P = 0.005) and radiotherapy(OR, 1.524; P<0.001) were independent risk factors for symptomatic PICC- VTE. Blood types A (OR, 1.404; P = 0.008), B (OR, 1.393; P = 0.016), and AB (OR, 1.861; P<0.001) were associated with a significantly higher risk of symptomatic PICC-VTE than blood type O. And the hematologic tumor has a significantly higher risk of PICC-VTE than breast cancer (OR, 0.149; P < 0.001), and gynecological tumor (OR, 0.386; P = 0.002). In the meta-analysis of the association between ABO blood type and PICC related thrombosis, the I2 statistic was not significant in any of the pairwise comparisons, and a fixed-effects model was subsequently used for all analyses. The meta-analysis indicated that the incidence of symptomatic PICC related thrombosis was significantly lower in individuals with the O blood type (3.30%) than in those with the A (4.92%), B (5.20%), or AB (6.58%) blood types (all P < 0.0083). However, in the pairwise comparisons among A, B, and AB, the differences were nonsignificant (P > 0.0083). CONCLUSIONS According to the results from our single center analysis, we found that myelosuppression, radiotherapy, hematologic tumor, and non-O blood type were independent risk factors for symptomatic PICC related thrombosis. In the meta-analysis of further exploration of ABO blood type and PICC related thrombosis, we found that ABO blood type may influence PICC related thrombosis, and individuals with the O blood type had a lower risk of PICC related thrombosis than those with non-O blood type.
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Affiliation(s)
- Xiao-Hong Wu
- Nursing Department, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center Affiliate Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Xiao
- Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Psychosomatic Medical Center,The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Ren-Di Tian
- Nursing Department, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center Affiliate Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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Hu Z, He R, Zhao Y, Luo M, Fan Y, Li J. Risk assessment models for PICC-related venous thrombosis in adult patients with cancer: A network meta-analysis. Thromb Res 2024; 239:109030. [PMID: 38735166 DOI: 10.1016/j.thromres.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES This review aims to compare the performance of available risk assessment models (RAMs) for predicting peripherally inserted central catheter-related venous thrombosis (PICC-RVT) in adult patients with cancer. METHODS A systematic search was conducted across ten databases from inception to October 20, 2023. Studies were eligible if they compared the accuracy of a RAM to that of another RAM for predicting the risk of PICC-RVT in adult patients with cancer. Two reviewers independently performed the study selection, data extraction and risk of bias assessments. A Bayesian network meta-analysis (NMA) was used to evaluate the performance of the RAMs. RESULTS A total of 1931 studies were screened, and 7 studies with 10 RAMs were included in the review. The most widely used RAMs were the Caprini (4 studies), Padua prediction score (3 studies), Autar (3 studies), Michigan risk score (2 studies) and Seeley score (2 studies). The sensitivity, specificity and accuracy varied markedly between the models. Notably, the Caprini score achieved higher sensitivity than 4 RAMs (Wells, Revised Geneva, modified MRS, MRS). The Michigan risk score had greater specificity than did the other 6 RAMs (Caprini, Autar, Padua, Seeley, the novel RAM, Wells). The predictive accuracy of the MRS is significantly greater than that of the Caprini and Autar RAM. CONCLUSION The MRS could be the most accurate RAM for identifying patients at high risk of PICC-RVT. However, as limited studies are available, more rigorous studies should be conducted to examine the accuracy of the Michigan risk score for PICC-RVT in different contexts.
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Affiliation(s)
- Zeyin Hu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Ruoying He
- Peking University Shenzhen Hospital, Shenzhen 518035, PR China
| | - Yu Zhao
- Peking University Shenzhen Hospital, Shenzhen 518035, PR China
| | - Mengna Luo
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Yuying Fan
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Jia Li
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
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Sheng Y, Gao W. Machine Learning Predicts Peripherally Inserted Central Catheters-Related Deep Vein Thrombosis Using Patient Features and Catheterization Technology Features. Clin Nurs Res 2024; 33:460-469. [PMID: 39076023 DOI: 10.1177/10547738241260947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
This study aims to use patient feature and catheterization technology feature variables to train the corresponding machine learning (ML) models to predict peripherally inserted central catheters-deep vein thrombosis (PICCs-DVT) and analyze the importance of the two types of features to PICCs-DVT from the aspect of "input-output" correlation. To comprehensively and systematically summarize the variables used to describe patient features and catheterization technical features, this study combined 18 literature involving the two types of features in predicting PICCs-DVT. A total of 21 variables used to describe the two types of features were summarized, and feature values were extracted from the data of 1,065 PICCs patients from January 1, 2021 to August 31, 2022, to construct a data sample set. Then, 70% of the sample set is used for model training and hyperparameter optimization, and 30% of the sample set is used for PICCs-DVT prediction and feature importance analysis of three common ML classification models (i.e. support vector classifier [SVC], random forest [RF], and artificial neural network [ANN]). In terms of prediction performance, this study selected four metrics to evaluate the prediction performance of the model: precision (P), recall (R), accuracy (ACC), and area under the curve (AUC). In terms of feature importance analysis, this study chooses a single feature analysis method based on the "input-output" sensitivity principle-Permutation Importance. For the mean model performance, the three ML models on the test set are P = 0.92, R = 0.95, ACC = 0.88, and AUC = 0.81. Specifically, the RF model is P = 0.95, R = 0.96, ACC = 0.92, AUC = 0.86; the ANN model is P = 0.92, R = 0.95, ACC = 0.88, AUC = 0.81; the SVC model is P = 0.88, R = 0.94, ACC = 0.85, AUC = 0.77. For feature importance analysis, Catheter-to-vein rate (RF: 91.55%, ANN: 82.25%, SVC: 87.71%), Zubrod-ECOG-WHO score (RF: 66.35%, ANN: 82.25%, SVC: 44.35%), and insertion attempt (RF: 44.35%, ANN: 37.65%, SVC: 65.80%) all occupy the top three in the ML models prediction task of PICCs-DVT, showing relatively consistent ranking results. The ML models show good performance in predicting PICCs-DVT and reveal a relatively consistent ranking of feature importance from the data. The important features revealed might help clinical medical staff to better understand and analyze the formation mechanism of PICCs-DVT from a data-driven perspective.
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Affiliation(s)
- Yuan Sheng
- Shandong University, Jinan, China
- Liaocheng University, Liaocheng, China
| | - Wei Gao
- Shandong University of Qilu Hospital, Jinan, China
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Cao Q, Wang Y. Effectiveness of nanoparticle-based antimicrobial agents in the prevention and treatment of Central Venous Catheter-Associated Bloodstream Infections. Comput Methods Biomech Biomed Engin 2024:1-13. [PMID: 38945158 DOI: 10.1080/10255842.2024.2310076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND In healthcare settings, Central Venous Catheter-Associated Bloodstream Infections (CVC-BSIs) present a serious problem since they raise morbidity, mortality, and medical expense rates. The management of these illnesses is made more challenging by the development of antimicrobiotic resistance. Nanotechnology has attracted interest recently as a viable method for creating new antimicrobial agents. By putting antibacterial nanomaterials onto the catheter's appear, that may reduce the likelihood of getting sick by stopping germs from adhering and growing. Antimicrobial additives can be released gradually finishes, protecting over time through bioengineering sectors. To prevent and treat CVC-BSIs, this study will assess the efficacy of antimicrobial medicines based on nanoparticles. METHODS In the network Meta-Analyses (MA) and Systematic Review (SR), we looked for studies published from January 2010 to September 2021 using the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, CINAHL, and Web of Science databases. Ten papers in all were included in the review following the screening of the publications using inclusion and exclusion criteria. RESULTS In contrast to conventional catheters, the implementation of Antimicrobial Catheters (AC) and the use of chlorhexidine (CHG) or Silver Sulfadiazine (SS) demonstrated notably reduced occurrences of Central Venous Catheter-Associated Bloodstream Infections (CVC-BSIs) per 1000 Catheter Days (CD) (with Odds Ratios (ORs) and 95% Credibility Intervals (CrIs) of 0.66 and 0.54, respectively) by bioengineering sectors. Moreover, these interventions were linked to the lowest rate of Catheter Colonization (CC), with ORs as well as 95% CrIs of 0.45 and 0.31, respectively, underscoring their potential as effective strategies for minimizing the risk of infections associated with catheter use as well as bioengineering sectors innovations. CONCLUSIONS As a result, CVC-BSI has shown significant promise for prevention and treatment with nanoparticle-based antimicrobial medicines. Due to their special characteristics and modes of action, they are strong candidates for improving the security and effectiveness of central venous catheter use in clinical settings. Due to ongoing research and development in this area, nanoparticle-based coatings and therapies may be used to lessen the impact of CVC-BSIs and enhance patient outcomes.
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Affiliation(s)
- Qianqian Cao
- Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yun Wang
- Northern Jiangsu People's Hospital, Yangzhou, China
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Dos Santos BN, Beato BVG, Ferreira EB, Braga FTMM, Dos Reis PED, Silveira RCDCP. Prevalence of PICC-related thrombosis in patients with hematological malignancies: a systematic review. Support Care Cancer 2024; 32:462. [PMID: 38922487 DOI: 10.1007/s00520-024-08636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To estimate the prevalence of peripherally inserted central catheter (PICC)-related venous thrombosis in patients with hematological malignancies. METHODS A systematic review of observational studies that evaluated the occurrence of PICC-related venous thrombosis in children, adults, and older people with hematological malignancies was conducted. Searches were carried out on June 12th, 2023 on PubMed, CINAHL, Embase, Web of Science Core Collection, Scopus, and LILACS, and to gray literature on Google Scholar, and ProQuest Dissertations and Theses Global. Eligibility criteria were applied independently by two reviewers, first on the titles and abstracts on the Rayyan platform and then on the full text of eligible studies. Risk of bias was assessed by the JBI checklist. Data were summarized descriptively, and the meta-analysis was carried out using the MetaXL 5.3 software. The review followed JBI guidelines and PRISMA for reporting. RESULTS In the 40 studies included, prevalence of PICC-related venous thrombosis was 9% in general, 9% in adults, and 6% in children with hematological malignancies. Most studies only evaluated cases of symptomatic thrombosis (n = 25; 64%). CONCLUSION Patients with hematological malignancies using PICC have an estimated prevalence of PICC-related venous thrombosis of 9%, and this rate may be underestimated due to the consideration of mostly symptomatic cases.
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Pinelli F, Muzzi M, Pittiruti M. Should ultrasound evaluation for catheter-related thrombosis always be required before PICC removal? J Vasc Access 2024; 25:697-702. [PMID: 36163680 DOI: 10.1177/11297298221125965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite several effective preventive strategies peripherally inserted central catheters (PICCs)-as much as centrally inserted central catheters and femorally inserted central catheters-are inevitably associated with the potential development of catheter-related thrombosis. This complication may be symptomatic or-more often-asymptomatic. Even if remote, the chance that PICC removal may mobilize an asymptomatic thrombus and cause pulmonary embolism, is theoretically possible. On the other hand, the diffuse adoption of an ultrasound scan aiming at detecting an asymptomatic catheter-related thrombosis may be logistically difficult and expensive. No clear evidence-based recommendations exist on this issue and whether perform an ultrasound scan before PICC removal in asymptomatic patients remains a matter of debate. For these reasons, the authors propose few common sense recommendations that may help clinicians in weighing the clinical advantages of the exam (optimal safety for the patient) versus its practical disadvantages (logistic cost).
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Affiliation(s)
- Fulvio Pinelli
- AOUC, Anesthesia and Intensive Care, Florence, Tuscany, Italy
| | - Mirko Muzzi
- School of Human Health Science, University of Florence, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, University Hospital Agostino Gemelli, Rome, Lazio, Italy
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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation. METHODS A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data. RESULTS From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies. CONCLUSION Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Zhang J, Wu Y, Zhang S, Yao W, Bu F, Wang A, Hu X, Wang G. Appraising the quality standard of clinical practice guidelines related to central venous catheter-related thrombosis prevention: a systematic review of clinical practice guidelines. BMJ Open 2024; 14:e074854. [PMID: 38471679 PMCID: PMC10936513 DOI: 10.1136/bmjopen-2023-074854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To evaluate the quality and analyse the content of clinical practice guidelines regarding central venous catheter-related thrombosis (CRT) to provide evidence for formulating an evidence-based practice protocol and a risk assessment scale to prevent it. DESIGN Scoring and analysis of the guidelines using the AGREE II and AGREE REX scales. DATA SOURCES Pubmed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and the Chinese Biomedical Literature, and the relevant websites of the guideline, were searched from 1 January 2017 to 26 March 2022. ELIGIBILITY CRITERIA Guidelines covering CRT treatment, prevention, or management were included from 1 January 2017 to 26 March 2022. DATA EXTRACTION AND SYNTHESIS Three independent reviewers systematically trained in using the AGREE II and AGREE REX scales were selected to evaluate these guidelines. RESULTS Nine guidelines were included, and the quality grade results showed that three were at A-level and six were at B-level. The included guidelines mainly recommended the prevention measure of central venous CRT from three aspects: risk screening, prevention strategies, and knowledge training, with a total of 22 suggestions being recommended. CONCLUSION The overall quality of the guidelines is high, but there are few preventive measures for central venous CRT involved in the guidelines. All preventive measures have yet to be systematically integrated and evaluated, and no risk assessment scale dedicated to this field has been recommended. Therefore, developing an evidence-based practice protocol and a risk assessment scale to prevent it is urgent.
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Affiliation(s)
- Jing Zhang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongya Wu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Shuai Zhang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenmo Yao
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Faqian Bu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Aoxue Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
| | - Guan Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, China
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Wang P, He L, Yuan Q, Lu J, Ji Q, Peng A, Liu W. Risk factors for peripherally inserted central catheter-related venous thrombosis in adult patients with cancer. Thromb J 2024; 22:6. [PMID: 38178101 PMCID: PMC10768137 DOI: 10.1186/s12959-023-00574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE The purpose of this study was to understand and analyze the risk factors of peripherally inserted central catheter (PICC)-related venous thrombosis in adult patients with cancer. METHODS This observational cohort study included adult patients with cancer who underwent color Doppler ultrasound at the Xiangya Hospital of Central South University, Hunan Provincial Maternal and Child Healthcare Hospital, and Xiangya Changde Hospital, Hunan Province, from January 1, 2017 to December 31, 2021. Univariate and multivariate logistic regression analyses were performed to determine the risk factors of PICC-related venous thrombosis. RESULTS After risk adjustment, multivariate logistic regression analysis revealed statistically significant associations between PICC-related venous thrombosis and age > 65 years old (OR: 1.791, CI: 1.343-2.389), male sex (OR: 1.398, CI: 1.057-1.849), white blood cell count > 9.5 × 109 /L (OR: 1.422, CI: 1.041-1.942), APTT < 25 s (OR: 2.006, CI: 1.431-2.811), gastrointestinal tumor (OR: 2.191, CI: 1.406-3.414), infection (OR:7.619, CI: 5.783-10.037), the use of cisplatin (OR: 2.374, CI: 1.714-3.214), vincristine (OR: 2.329, CI: 1.447-3.749), the use of polyurethane (OR: 2.449, CI: 1.863-3.219) and open-ended catheters (OR:1.660, CI: 1.131-2.439), keeping time of the catheter (days) (OR: 1.003, CI: 1.001-1.005) were associated with PICC-related venous thrombosis. CONCLUSION We identified that the presence of age > 65 years old, male sex, white blood cell count > 9.5 × 109 /L, APTT < 25 s, gastrointestinal tumor, infection, the use of cisplatin and vincristine, the use of polyurethane, open-ended catheters and keeping time of the catheter (days), were associated with PICC-related venous thrombosis.
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Affiliation(s)
- Pinghu Wang
- Breast Surgery Department, Hunan Provincial Maternal and Child Healthcare Hospital, Changsha, Hunan, People's Republic of China
| | - Lianxiang He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Qiong Yuan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Juan Lu
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Qingqiong Ji
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - An Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wanli Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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Chen L, Lu Y, Wang L, Pan Y, Zhou X. Construction of a nomogram risk prediction model for PICC-related venous thrombosis and its application. Asian J Surg 2024; 47:107-111. [PMID: 37302889 DOI: 10.1016/j.asjsur.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/07/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To explore the risk factors of the peripherally inserted central catheter (PICC)-related venous thrombosis and correspondingly construct a nomogram risk prediction model. METHODS The clinical data of 401 patients receiving PICC catheterization in our hospital from June 2019 to June 2022 were retrospectively analyzed. The independent influencing factors for venous thrombosis were predicted using logistic regression analysis, and significant indicators were screened to construct a nomogram for predicting PICC-related venous thrombosis. The difference in predictive efficacy between simple clinical data and nomogram was analyzed using a receiver operating characteristic (ROC) curve, and the nomogram was internally validated. RESULTS Single-factor analysis showed that catheter tip position, plasma D-dimer concentration, venous compression, malignant tumor, diabetes, history of thrombosis, history of chemotherapy, and history of PICC/CVC catheterization were correlated with PICC-related venous thrombosis. Further multi-factor analysis revealed that catheter tip position, plasma D-dimer elevation, venous compression, history of thrombosis and history of PICC/CVC catheterization were the risk factors for PICC-related venous thrombosis. Based on binary logistic regression analysis, a nomogram prediction model for PICC-related venous thrombosis was constructed. The area under the curve (AUC) was 0.876 (95%CI: 0.818-0.925), with a statistically significant difference (P < 0.01). CONCLUSION The independent risk factors for PICC-related venous thrombosis are screened out, including catheter tip position, plasma D-dimer elevation, venous compression, history of thrombosis and history of PICC/CVC catheterization, and a nomogram prediction model with good effect is constructed to predict the risk of PICC-related venous thrombosis.
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Affiliation(s)
- Lili Chen
- Department of Traditional Chinese Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yanyan Lu
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Lei Wang
- Department of PICC Catheter Maintenance Clinic, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yihong Pan
- Department of Traditional Chinese Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaoyan Zhou
- Department of Traditional Chinese Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China.
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Yu C, Sun S, Shi X, Wang L, Zhang Q, Zhang L, Song D. Preventive effect of aspirin on peripherally inserted central catheter-related vein thrombosis in patients with malignant tumors. JOURNAL OF VASCULAR NURSING 2023; 41:153-157. [PMID: 38072566 DOI: 10.1016/j.jvn.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/06/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
The majority of patients receiving chemotherapy undergo PICC catheterization. However, PICCs are significantly associated with catheter related complications, including deep vein thrombosis, blood infection, fibrin sheath, catheter prolapse, catheter displacement and blockage. Of all the risks, PICC-related VT was the most prevailing clinic symptom and resulted in a high risk of death. AIM The study aimed to investigate the preventive efficacy and safety of aspirin for patients with malignant tumors receiving venous thrombosis (VT) related with peripherally inserted central catheters (PICC) treatment. PATIENTS AND METHODS A randomized controlled trial was conducted. Participants with malignant tumors receiving chemotherapy who accepted PICC insertion operation were randomly allocated to the aspirin treatment group (n = 235) or the control group (n = 246). The patients in the aspirin group were administrated aspirin (100mg) for 30 days, whereas the patients in control group were administrated a placebo drug. The incidence of PICC-related VT in both groups and the aspirin related adverse effects were evaluated. RESULTS The incidence of PICC-related VT was 0.4% in the aspirin group, compared with 3.3% in the control group (P = 0.038). In addition, aspirin related bleeding was not observed. CONCLUSION PICC-related VT could be effectively prevented by aspirin in patients with malignant tumors.
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Affiliation(s)
- Caiyan Yu
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Shaohua Sun
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Xiuqing Shi
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Li Wang
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Qian Zhang
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Lin Zhang
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Dehua Song
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China.
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Liu R, Xu H, Pu L, Xie X, Chen H, Wu Z, Chen H, Zhang X. Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy: a prospective and observational study. BMC Cancer 2023; 23:894. [PMID: 37736715 PMCID: PMC10515037 DOI: 10.1186/s12885-023-11413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE The incidence of peripherally inserted central catheter (PICC)-related complications is higher in cancer patients than in noncancer patients. However, the pattern of specific complication occurrence over time remains unclear. The purpose of this study was to investigate the clinical characteristics of PICC-related complications in cancer patients undergoing chemotherapy. METHODS This prospective, observational study was conducted at a university-affiliated hospital in Western China. Cancer patients undergoing PICC insertion for anticancer treatment were recruited and followed up until the first week after catheter removal. Any complications, including occurrence time and outcomes, were recorded. The trajectory of specific PICC-related complications over time were identify based on the Kaplan‒Meier curve analysis. RESULTS Of the 233 patients analyzed, nearly half (n = 112/233, 48.1%) developed 150 PICC-related complication events. The most common were symptomatic catheter-related thrombosis (CRT) (n = 37/233, 15.9%), medical adhesive-related skin injury (MARSI) (n = 27/233, 11.6%), and catheter dislodgement (n = 17/233, 7.3%), accounting for 54.0% (n = 81/150, 54.0%) of total complications events. According to Kaplan‒Meier curve analysis, symptomatic CRT, pain, phlebitis, and insertion site bleeding were classified as the "early onset" group mainly occurring within the first month post-insertion. Catheter fracture and catheter-related bloodstream infection were classified as the "late onset" group occurring after the second month post-insertion. MARSI, catheter dislodgement, occlusion, and insertion site infection were classified as the "persistent onset" group persistently occurring during the whole catheter-dwelling period. Among the 112 patients with PICC-related complications, 50 (44.6%) patients had their catheters removed due to complications, and 62 (55.4%) patients successfully retained their catheters until treatment completion through conventional interventions. The major reasons for unplanned catheter removal were catheter dislodgement (n = 12/233, 5.2%), symptomatic CRT (n = 10/233, 4.3%), and MARSI (n = 7/233, 3.0%), accounting for 58.0% (n = 29/50, 58.0%) of the total unplanned catheter removal cases. Catheter dwelling times between patients with complications under successful interventions (130.5 ± 32.1 days) and patients with no complications (138.2 ± 46.4 days) were not significantly different (t = 1.306, p = 0.194; log-rank test = 2.610, p = 0.106). CONCLUSIONS PICC-related complications were pretty common in cancer patients undergoing chemotherapy. The time distribution of PICC-related complications varied, and medical staff should develop time-specific protocols for prevention. Because more than half of the patients with PICC-related complications could be managed with conventional interventions, PICCs remain a priority for cancer patients undergoing short-term chemotherapy. The study was registered in 02/08/2019 at Chinese Clinical Trial Registry (registration number: ChiCTR1900024890).
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Affiliation(s)
- Ruixia Liu
- Department of Nursing, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Huiqiong Xu
- Division of Abdominal Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Lihui Pu
- Menzies Health Institute & School of Nursing and Midwifery, Griffith University, Brisbane Queensland, Australia
- Griffith University, Nathan Campus, Brisbane Queensland, PO Box 4111, Australia
| | - Xiaofeng Xie
- Department of Nursing, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Hongxiu Chen
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Huirong Chen
- Department of Nursing, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Xiaoxia Zhang
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China.
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, No.37 Guo Xue Street, PO Box 610041, West, Chengdu, Sichuan Province, P.R. China.
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13
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Zhang X, Chen H, Jing W, Pu L, Wu Z, Su X, Chen H, Liu J, Yu H, Hu X. The clinical topography of peripherally inserted central catheter-related thrombosis in cancer patients: A prospective and longitudinal observational study based on ultrasound scans every two days. Thromb Res 2023; 229:232-242. [PMID: 37572590 DOI: 10.1016/j.thromres.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
AIMS To delineate the clinical topography of peripherally inserted central catheter (PICC)-related thrombosis in cancer patients. BACKGROUND Most of the clinical features of PICC-related thrombosis are based on a single follow-up, which is insufficient to reflect the full topography of a thrombosis. DESIGN This is an observational study conducted at West China Hospital, according to the STROBE guidelines. METHODS Cancer patients scheduled for PICC placement were potentially eligible; patients with contraindications to PICC placement or existing diseases affecting blood flow were excluded; and those who later withdrew or did not reply to our contact request during the follow-up period were eliminated from this study. Ultrasound was used to detect thrombosis from the insertion site, proximal insertion site, axillary vein to the subclavian vein once every two days for two weeks post insertion. The thrombosis and its involved venous segments, onset time and symptoms and signs were recorded. RESULTS Among the 173 included patients, 126 (72.8 %) were identified as having thrombosis. Specifically, 113 and 126 patients were identified as having thrombosis within the first three days and the first week post insertion, respectively. In the 126 patients, thrombosis occurred at the insertion site (72.8 %) concurrently with thrombosis at the proximal insertion site (n = 120, 69.4 %), thrombosis in the axillary vein (n = 94, 54.3 %), and/or thrombosis in the subclavian vein (n = 41, 23.7 %). The log-rank test demonstrated that thrombosis in these four venous segments decreased significantly from the distal to the proximal central vein (log-rank test = 117.128, P < .001). Of 31 patients (17.9 %) who presented symptomatic thrombosis, only five patients experienced obvious swelling in the upper arm, and the other 26 patients exhibited atypical symptoms, such as soreness, tightness, numbness, tingling, or other discomforts in the palm, arm, armpit, and/or shoulder. In some thrombotic cases, ultrasonic assessment of PICC-related thrombosis did not parallel clinical symptoms and signs. CONCLUSION PICC-related thrombosis is common and can occur very early post insertion in cancer patients, and most thromboses present atypical symptoms. More than half of the cases with thrombosis evaluated involve multiple venous segments, and the farther the venous segments are from the central vein, the higher the incidence of thrombosis tend to be and the earlier the onset time are. RELEVANCE TO CLINICAL PRACTICE The results highlight the importance that medical staff pay particular attention to patients with catheters in the first week post insertion and be alert to thrombosis presenting atypical symptoms while keeping in mind that clinical symptoms and signs are not reliable for diagnosing thrombosis. CLINICAL REGESTRATION Clinical Trials ChiCTR1900024890.
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Affiliation(s)
- Xiaoxia Zhang
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; West China School of Nursing, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Hongxiu Chen
- West China School of Nursing, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Wenli Jing
- Department of Ultrasound, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Lihui Pu
- Menzies Health Institute & School of Nursing and Midwifery, Griffith University, PO Box 4111, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Xiaotian Su
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Huirong Chen
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Juan Liu
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Huaqin Yu
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Xiuying Hu
- Department of Ultrasound, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China
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14
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Ma S, Shen C, Li Q, Yang H, Hu Y, Wei X, Liang T. Clinical factors of PICC-RVT in cancer patients: a meta-analysis. Support Care Cancer 2023; 31:393. [PMID: 37314592 DOI: 10.1007/s00520-023-07855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE There is a lack of studies that systematically evaluate the clinical factors of PICC-RVT such as treatment, tumor stage, metastasis, and chemotherapy drugs in cancer patients. This study, therefore, aims to evaluate the clinical factors of catheter-related venous thrombosis in cancer patients with indwelling PICC to provide a basis for the clinical prevention and reduction of thrombosis. METHODS Relevant studies were retrieved from major databases (PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Data, and China Biology Medicine disc (CMB)) and searched from their earliest available dates until July 2022. If two or more studies had the same outcome, a meta-analysis using RevMan 5.4.1 was performed. This systematic review was registered at PROSPERO (number CRD42022358426). RESULTS A total of 19 articles involving 19,824 patients were included for quantitative analysis. Meta-analysis of these studies indicated that a history of chemotherapy, tumor type, tumor stage, presence or absence of metastasis, and use of fluorouracil, etoposide, platinum drugs, and taxane were all risk factors for PICC catheter thrombosis in cancer patients. CONCLUSION In clinical PICC catheter thrombosis prevention, patients with the above characteristics should be watched more closely than other patients, as they have a higher risk for PICC catheter thrombosis. Based on the present evidence at hand, radiotherapy cannot be considered to be related to the formation of PICC-RVT in cancer patients.
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Affiliation(s)
- Shengmiao Ma
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, Beijing, 100730, China
| | - Chen Shen
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, Beijing, 100730, China
| | - Qiuyue Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, Beijing, 100730, China
| | - Haojie Yang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, Beijing, 100730, China
| | - Yule Hu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, Beijing, 100730, China
| | - Xiaolei Wei
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, Beijing, 100730, China
| | - Tao Liang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, Beijing, 100730, China.
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Bonfim ALV, de Brito GA, Baptista AL, Andrade LAS, Imanishe MH, Pereira BJ. Clinical study of complications of a peripherally inserted central catheter in cancer patients. Nurs Open 2023. [PMID: 36853924 DOI: 10.1002/nop2.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/17/2022] [Accepted: 02/05/2023] [Indexed: 03/01/2023] Open
Abstract
AIM To evaluate complications after PICC use in cancer patients. DESIGN This was a clinical and retrospective study in which the risk factors and complications of PICC use were evaluated. METHODS This study was carried out in the patient, emergency room, and intensive care units through the evaluation of electronic medical records. To assess the association between qualitative variables, the chi-squared test or Fisher's exact test was used, and to compare the reason for withdrawal, the Kruskal-Wallis test was applied. RESULTS A total of 359 patients (53.5% men) with 43.1 ± 14 years who had a PICC (88% with solid tumours) were evaluated. The most common complications were mechanical complications (61.2%), infection (38%), and thrombosis (57.1%). Patients with double-lumen catheters experienced thrombosis (85.7%). This study demonstrated the effectiveness of PICC and that patients with haematological cancer are more prone to multiple PICC passages and more mechanical complications and infections.
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16
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Development and validation of a prediction model of catheter-related thrombosis in patients with cancer undergoing chemotherapy based on ultrasonography results and clinical information. J Thromb Thrombolysis 2022; 54:480-491. [PMID: 35972592 PMCID: PMC9553810 DOI: 10.1007/s11239-022-02693-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 12/24/2022]
Abstract
Central venous catheters can be used conveniently to deliver medications and improve comfort in patients with cancer. However, they can cause major complications. The current study aimed to develop and validate an individualized nomogram for early prediction of the risk of catheter-related thrombosis (CRT) in patients with cancer receiving chemotherapy. In total, 647 patients were included in the analysis. They were randomly assigned to the training (n = 431) and validation (n = 216) cohorts. A nomogram for predicting the risk of CRT in the training cohort was developed based on logistic regression analysis results. The accuracy and discriminatory ability of the model were determined using area under the receiver operating characteristic curve (AUROC) values and calibration plots. Multivariate logistic regression analysis showed that body mass index, risk of cancer-related thrombosis, D-dimer level, and blood flow velocity were independent risk factors of CRT. The calibration plot showed an acceptable agreement between the predicted and actual probabilities of CRT. The AUROC values of the nomogram were 0.757 (95% confidence interval: 0.717-0.809) and 0.761 (95% confidence interval: 0.701-0.821) for the training and validation cohorts, respectively. Our model presents a novel, user-friendly tool for predicting the risk of CRT in patients with cancer receiving chemotherapy. Moreover, it can contribute to clinical decision-making.
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Fu J, Cai W, Zeng B, He L, Bao L, Lin Z, Lin F, Hu W, Lin L, Huang H, Zheng S, Chen L, Zhou W, Lin Y, Fu F. Development and validation of a predictive model for peripherally inserted central catheter-related thrombosis in breast cancer patients based on artificial neural network: A prospective cohort study. Int J Nurs Stud 2022; 135:104341. [DOI: 10.1016/j.ijnurstu.2022.104341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/21/2022] [Accepted: 08/02/2022] [Indexed: 10/31/2022]
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Puri A, Dai H, Giri M, Wu C, Huang H, Zhao Q. The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:917572. [PMID: 35958406 PMCID: PMC9360324 DOI: 10.3389/fcvm.2022.917572] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Venous thromboembolism (VTE) can be fatal if not treated promptly, and individual studies have reported wide variability in rates of VTE associated with peripherally inserted central catheters (PICC). We thus conducted this meta-analysis to investigate the overall incidence and risk of developing PICC-related VTE in hospitalized patients. Methods We searched PubMed, Embase, Scopus, and Web of Science databases from inception until January 26, 2022. In studies with a non-comparison arm, the pooled incidence of PICC-related VTE was calculated. The pooled odds ratio (OR) was calculated to assess the risk of VTE in the studies that compared PICC to the central venous catheter (CVC). The Newcastle-Ottawa Scale was used to assess methodological quality. Results A total of 75 articles (58 without a comparison arm and 17 with), including 109292 patients, were included in the meta-analysis. The overall pooled incidence of symptomatic VTE was 3.7% (95% CI: 3.1–4.4) in non-comparative studies. In the subgroup meta-analysis, the incidence of VTE was highest in patients who were in a critical care setting (10.6%; 95% CI: 5.0–17.7). Meta-analysis of comparative studies revealed that PICC was associated with a statistically significant increase in the odds of VTE events compared with CVC (OR, 2.48; 95% CI, 1.83–3.37; P < 0.01). However, in subgroup analysis stratified by the study design, there was no significant difference in VTE events between the PICC and CVC in randomized controlled trials (OR, 2.28; 95% CI, 0.77–6.74; P = 0.13). Conclusion Best practice standards such as PICC tip verification and VTE prophylaxis can help reduce the incidence and risk of PICC-related VTE. The risk-benefit of inserting PICC should be carefully weighed, especially in critically ill patients. Cautious interpretation of our results is important owing to substantial heterogeneity among the studies included in this study.
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Affiliation(s)
- Anju Puri
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyun Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengfei Wu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Qinghua Zhao,
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Yue J, Zhang Y, Xu F, Mi A, Zhou Q, Chen B, Shi L. A clinical study of peripherally inserted central catheter-related venous thromboembolism in patients with hematological malignancies. Sci Rep 2022; 12:9871. [PMID: 35701467 PMCID: PMC9197841 DOI: 10.1038/s41598-022-13916-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
This study aimed to explore the risk factors of peripherally inserted central catheter (PICC)-related venous thromboembolism (CRT) in patients with hematological malignancies and the predictive ability of the thrombotic risk assessment models (RAMs). The clinical data of the 117 eligible patients with hematological neoplasms at Mianyang Central Hospital with PICC from May 2018 to May 2020 were analyzed in this retrospective study. Thrombosis risk scores were calculated in patients with image-confirmed PICC-related thromboembolism. CRT occurred in 19 cases. Compared to the CRT-free group, the CRT group was older and showed higher body mass index (BMI), leukocyte count level, and the prevalence of diabetes mellitus. Multivariable logistic regression analysis showed that BMI (P = 0.03) was a significant risk factor for CRT. The area under the receiver operating characteristic curve for the Caprini scale (P = 0.01) was higher than that of the modified Wells scale (P = 0.94), the revised Geneva scale (P = 0.83), Padua scale (P = 0.59), and Michigan scale (P = 0.80). The sensitivity and specificity for the Caprini scale, Padua scale, modified Wells scale, the revised Geneva scale, and Michigan risk score were 63.3%/73.7%, 100%/0.00%, 95.9%/5.3%, 31.6%/73.7%, and 1.0%/99.0%, respectively. Caprini RAM had a better predictive ability for CRT in patients with hematological malignancies. Michigan risk score may not be better than Caprini RAM in this population.
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Affiliation(s)
- Jing Yue
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Ya Zhang
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Fang Xu
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China.
| | - Ai Mi
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Qiaolin Zhou
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Bin Chen
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Lin Shi
- Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
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20
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Simonetti G, Bersani A, Tramacere I, Lusignani M, Gaviani P, Silvani A. The role of body mass index in the development of thromboembolic events among cancer patients with PICCs: a systematic review. JOURNAL OF VASCULAR NURSING 2022; 40:11-16. [DOI: 10.1016/j.jvn.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/14/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022]
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21
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Kuang Z, Liu X, Zhu Y, Xie H, Liu Y. A retrospective cohort study of disease-related risk factors for central venous catheter-related symptomatic thrombosis in intensive care unit inpatients. Medicine (Baltimore) 2021; 100:e26732. [PMID: 34398049 PMCID: PMC8294906 DOI: 10.1097/md.0000000000026732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023] Open
Abstract
Central venous catheters (CVC) are widely used in critically ill patients given their benefits in monitoring vital signs, treatment administration, and renal replacement therapy in intensive care unit (ICU) patients, but these catheters have the potential to induce symptomatic catheter-related venous thrombosis (CRVT). This study reported the rate of symptomatic CRVT in ICU patients receiving CVC and analyzed the disease-related risk factors for symptomatic CRVT in ICU patients.A retrospective analysis was performed on the consecutive ICU 1643 critically ill patients with CVCs inserted from January 2015 to December 2019. Symptomatic CRVT was confirmed by ultrasound. CVCs were divided into 2 groups based on the presence of symptomatic CRVT, and the variables were extracted from the electronic medical record system. Logistic univariate and multivariate regression analyses were used to determine the disease-related risk factors of symptomatic CRVT.A total of 209 symptomatic CRVT events occurred among 2114 catheters. The rate of CRVT was 9.5 per 1000 catheter days. Univariate analysis revealed that trauma, major surgery, heart failure, respiratory failure, and severe acute pancreatitis were risk factors for symptomatic CRVT in the ICU. Multivariate analysis showed that trauma (odds ratio [OR], 2.046; 95% confidence interval [CI] [1.325-3.160], P = .001), major surgery (OR, 2.457; 95% CI [1.641-3.679], P = .000), and heart failure (OR, 2.087; 95% CI [1.401-3.111], P = .000) were independent disease-related risk factors for symptomatic CRVT in ICU. The C-statistic for this model was 0.61 (95% CI [0.57-0.65], P = .000).The incidence rate of symptomatic CRVT in the ICU population was 9.5 per 1000 catheter days. Trauma, major surgery, and heart failure are independent disease-related risk factors of symptomatic CRVT.
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Affiliation(s)
- Zhiming Kuang
- Department of Intensive Care Unit, Ganzhou People's Hospital, Ganzhou, Jiangxi Province, People's Republic of China
| | - Xiaochun Liu
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi Province, People's Republic of China
| | - Yunlin Zhu
- Department of Intensive Care Unit, Ganzhou People's Hospital, Ganzhou, Jiangxi Province, People's Republic of China
| | - Hailiang Xie
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi Province, People's Republic of China
| | - Yuanfei Liu
- Department of Intensive Care Unit, Ganzhou People's Hospital, Ganzhou, Jiangxi Province, People's Republic of China
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The effect of systemic and local risk factors on triggering peripherally inserted central catheter-related thrombosis in cancer patients: A prospective cohort study based on ultrasound examination and structural equation modeling. Int J Nurs Stud 2021; 121:104003. [PMID: 34273807 DOI: 10.1016/j.ijnurstu.2021.104003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The negative synergistic effect of cancer and a peripherally inserted central catheter could significantly increase the incidence of thrombosis. Rather than identifying risk factors for peripherally inserted central catheter-related thrombosis, exploring the effect of these risk factors might be a promising method to improve the outcomes of thrombosis. OBJECTIVES To analyze the effect of systemic and local risk factors on triggering peripherally inserted central catheter-related thrombosis in the first two weeks post-insertion in cancer patients. DESIGN A prospective cohort study. SETTING The study was conducted at a 4500-bed university-affiliated medical center in China. PARTICIPANTS One hundred seventy-three cancer patients with peripherally inserted central catheters were included. METHODS Peripherally inserted central catheter-related thrombosis was assessed using ultrasound at a series of timepoints, once every two days post-insertion. Data on age, body mass index, blood hypercoagulation, insertion attempts, catheter-to-vein ratio, and blood flow velocity were collected as risk factors. Descriptive statistics and structural equation modeling were used to describe the study samples and analyze the effects of systemic and local risk factors. RESULTS Among the 173 cancer patients included, 126 (72.8%) patients were diagnosed with peripherally inserted central catheter-related thrombosis. Most thromboses (n = 118, 93.7%) were detected within five days, and 100% were detected within nine days post-insertion. Structural equation modeling analysis showed that local risk factors [catheter-to-vein ratio (standardized path coefficient = 0.32, p < 0.05) and blood flow velocity (standardized path coefficient = -0.35, p < 0.05)] had a greater effect than systemic factors [age (standardized path coefficient = 0.13, p < 0.05) and blood hypercoagulation (standardized path coefficient = 0.17, p < 0.05)] on triggering peripherally inserted central catheter-related thrombosis. CONCLUSION Peripherally inserted central catheter-related thrombosis is quite common and can occur very early post-insertion in cancer patients. Among the common risk factors, local risk factors reflecting peripherally inserted central catheter technology itself had a greater effect than systemic risk factors reflecting predisposition to thrombosis. Clinical Registration: Clinical Trials ChiCTR1900024890.
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Feng Y, Zheng R, Fu Y, Xiang Q, Yue Z, Li J, Yu C, Jiang Y. Assessing the thrombosis risk of peripherally inserted central catheters in cancer patients using Caprini risk assessment model: a prospective cohort study. Support Care Cancer 2021; 29:5047-5055. [PMID: 33594508 DOI: 10.1007/s00520-021-06073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE There was no optimal risk assessment tool to stratify the risk of peripherally inserted central catheter-related venous thromboembolism (PICC-RVT) in cancer patients. We currently use the Caprini risk assessment model for thrombotic risk assessment, but no evidence exists on the effectiveness of Caprini in such patients. This study was to assess the validity of the Caprini in Chinese cancer patients with PICCs. METHODS We conducted a prospective study of 468 participants. Following calculating the Caprini score, color Doppler ultrasonography was performed every 7 days for 3 weeks to confirm PICC-RVT. RESULTS There was a correlation between PICC-RVT and the Caprini score. Compared with scores of 5, the risk was 2.089-fold greater (95% CI 1.165-3.743, P = 0.012) in patients with a score of 6 and 7, and 7.156-fold greater (95% CI 3.157-16.217, P < 0.001) in patients with scores ≥8. The area under the receiver-operating characteristic curve was 0.636 (95% CI 0.590-0.680; P < 0.001). 6 was the best cutoff point for Caprini, with a sensitivity of 0.76 and a specificity of 0.44. CONCLUSIONS The Caprini can be used for high-risk screening of the PICC-RVT in cancer patients, and classification of the highest risk level using a score of 6 can be more clinically significant compared to 5 as recommended. The results provide evidence for the practitioner's early use of the Caprini to assess the thrombotic risk in patients with PICCs and take timely prevention measures. But pharmacological prevention should be considered seriously for its low specificity.
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Affiliation(s)
- Yue Feng
- West China School of Nursing/Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Rujun Zheng
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Fu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiufen Xiang
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiying Yue
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Junying Li
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
| | - Chunhua Yu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China.
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Chen P, Wan G, Zhu B. Incidence and risk factors of symptomatic thrombosis related to peripherally inserted central catheter in patients with lung cancer. J Adv Nurs 2020; 77:1284-1292. [PMID: 33249623 DOI: 10.1111/jan.14666] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/14/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
AIMS To determine the incidence and risk factors associated with peripherally inserted central catheter-related thrombosis (PICC-RT) in patients with lung cancer. DESIGN A retrospective cross-sectional design. METHODS Patients with lung cancer receiving PICC insertion during 1 March 2014-31 May 2019 at a tertiary hospital in Shanghai, China were enrolled (N = 748). Symptomatic PICC-RT was confirmed by Doppler ultrasonography in the presence of clinical symptoms and signs. Univariate and multivariate logistic regression analyses were performed to identify risk factors of symptomatic PICC-RT. RESULTS Among the patients (mean age, 60.7 years; males, 67.1%), 55 (7.35%) had symptomatic PICC-RT. Based on the multivariate analysis, history of smoking [OR 2.49 (1.13-5.46), p < .05], use of Carboplatin [OR 2.23 (1.19-4.17), p < .05] or Docetaxel [OR 7.23 (1.65-31.56), p < .05], PICC size [OR 3.52 (1.78-6.99), p < .001], and level of D-dimer [OR 5.32 (2.39-11.83), p < .001] were significant risk factors of PICC-RT. CONCLUSION Several modifiable factors (e.g., PICC size and level of D-dimer) were related to PICC-RT. In the future, prospective studies are warranted to examine whether those factors could increase the risk of PICC-RT. Meanwhile, healthcare professionals are recommended to perform a comprehensive assessment of the patients receiving PICC insertion. Close attention should be paid to those at risk for PICC-RT. IMPACT Identification of risk factors associated with PICC-RT is an important step towards individualizing the care plan for patients receiving PICC. Our findings provided evidence for the management of PICC-RT in patients with lung cancer. In clinical practice, nurses could deliver appropriate interventions against modifiable risk factors to reduce the risk of PICC-RT.
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Affiliation(s)
- Pei Chen
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Guangming Wan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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Haggstrom L, Parmar G, Brungs D. Central Venous Catheter Thrombosis in Cancer: A Multi-Centre Retrospective Study Investigating Risk Factors and Contemporary Trends in Management. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2020; 14:1179554920953097. [PMID: 32943968 PMCID: PMC7466879 DOI: 10.1177/1179554920953097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
Objectives: Central venous access is needed to facilitate chemotherapy for many cancer patients. Central venous catheter-related thrombosis (CVCT) is a major complication that can cause significant morbidity and mortality. We sought to explore the rate of CVCT in a general cancer population in Australia and to identify factors associated with increased risk of thrombosis. Design: This is a multi-centre retrospective cohort study. Setting and participants: We analysed key patient, treatment, and cancer-related factors for 317 patients with cancer and central venous catheters inserted for systemic therapy. Main outcome measures: Symptomatic CVCT confirmed with imaging and management of patients with CVCT. Results: A total of 402 cases of central line insertion were analysed. Central venous catheter-related thrombosis occurred in 24 patients (6.0%). Having a peripherally inserted central catheter (PICC; HR = 3.78, 95% CI = 1.28-11.19, P = .02) compared with an implantable port and a body mass index of ⩾25.0 kg/m2 (HR = 3.60, 95% CI = 1.31-9.85, P = .01) were independently associated with increased risk of thrombosis. Central venous catheter-related thrombosis was managed mostly with removal of the catheter (19 of 24 cases) and anticoagulation, including direct-acting oral anticoagulants in 5 patients. Conclusions: This work explored rates of CVCT in a general cancer population, observing increased rates in those with PICCs or increased body mass index.
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Affiliation(s)
- Lucy Haggstrom
- Department of Medical Oncology, The Wollongong Hospital, Wollongong, NSW, Australia
- Lucy Haggstrom, Department of Medical Oncology, The Wollongong Hospital, Loftus St, Wollongong, NSW 2500, Australia.
| | - Gurdeep Parmar
- Department of Haematology, The Wollongong Hospital, Wollongong, NSW, Australia
| | - Daniel Brungs
- Department of Medical Oncology, The Wollongong Hospital, Wollongong, NSW, Australia
- Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
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