Peripherally Inserted Central Catheter-Related Vein Thrombosis in Breast Cancer Patients

Incidence and risk factors of PICC-related thrombosis in breast cancer: a meta-analysis

BACKGROUND

The incidence and risk factors of peripherally inserted central catheter-related thrombosis in patients with breast cancer have not been fully elucidated.

METHOD

Meta-analysis was performed by searching all studies on the incidence of peripherally inserted central catheter-associated thrombosis and risk factors for its formation in breast cancer patients from the establishment of the database to May 2023, including PubMed, Embase, Web of Science, China Knowledge Network, China Biomedical Literature Service System (SinoMed) and Wanfang databases. Then the incidence of peripherally inserted central catheter-related thrombosis and risk factors for its formation were analyzed in breast cancer patients.

RESULTS

A total of 15 articles were included, involving 8635 patients. The total incidence of peripherally inserted central catheter-related thrombosis in breast cancer patients was 7.0% (95% confidence interval: 4.0-13.0%) and 12.9% (95% confidence interval: 7.0-22.5%) after correction. Thirty-two risk factors were included, and eight risk factors could be combined. Among these risk factors, there were statistically significant differences (P < 0.05) in body mass index ≥ 25 (odds ratio = 6.319, 95% confidence interval: 2.733-14.613; P < 0.001), D-dimer >500 ng/ml (odds ratio = 1.436, 95% confidence interval: 1.113-1.854; P = 0.005), increased fibrinogen (odds ratio = 4.733, 95% confidence interval: 1.562-14.346; P = 0.006), elevated platelet count (odds ratio = 4.134, 95% confidence interval: 2.694-6.346; P < 0.001) and catheter malposition (odds ratio = 8.475, 95% confidence interval: 2.761-26.011; P < 0.001).

CONCLUSION

The incidence rate of peripherally inserted central catheter-related thrombosis in breast cancer patients was 7.0% (95% confidence interval: 4.0-13.0%). Body mass index ≥ 25, D-dimer >500 ng/ml, elevated fibrinogen, elevated platelet count and catheter malposition were risk factors for peripherally inserted central catheter-related thrombosis in breast cancer patients.

Outcome of antithrombotic therapy in cancer patients with catheter-related thrombosis: a systematic review

Introduction

The guidelines' recommendations for anticoagulation in cancer patients with catheter-related thrombosis are unclear. The aim of this systematic review was to assess anticoagulation management in cancer patients with catheter-related thrombosis (CRT) based on previously published studies.

Methods

As of June 10, 2023,we searched databases including PubMed, Embase, and Cochrane and included 11 observational studies that met the criteria. We evaluated 770 adults with active cancer and objectively confirmed patients with CRT who were using drugs including warfarin, LMWH, and new oral anticoagulants as antithrombotic therapy.

Results

We extracted outcome data, including thrombosis recurrence, catheter dysfunction, major bleeding, and death, and performed a meta-analysis.

Discussion

In this study we found that the risk of VTE recurrence was higher with rivaroxaban, the risk of bleeding and death appeared to be greater with warfarin, and although the risk of catheter dysfunction due to LMWH is a concern, it is still a more reasonable option for cancer patients with catheter-related thrombosis.

Systematic Review Registration

http://www.clinicaltrials.gov, identifier (CRD42022367979).

Risk Factors and Predictive Models for Peripherally Inserted Central Catheter Unplanned Extubation in Patients With Cancer: Prospective, Machine Learning Study

BACKGROUND

Cancer indeed represents a significant public health challenge, and unplanned extubation of peripherally inserted central catheter (PICC-UE) is a critical concern in patient safety. Identifying independent risk factors and implementing high-quality assessment tools for early detection in high-risk populations can play a crucial role in reducing the incidence of PICC-UE among patients with cancer. Precise prevention and treatment strategies are essential to improve patient outcomes and safety in clinical settings.

OBJECTIVE

This study aims to identify the independent risk factors associated with PICC-UE in patients with cancer and to construct a predictive model tailored to this group, offering a theoretical framework for anticipating and preventing PICC-UE in these patients.

METHODS

Prospective data were gathered from January to December 2022, encompassing patients with cancer with PICC at Xiangya Hospital, Central South University. Each patient underwent continuous monitoring until the catheter's removal. The patients were categorized into 2 groups: the UE group (n=3107) and the non-UE group (n=284). Independent risk factors were identified through univariate analysis, the least absolute shrinkage and selection operator (LASSO) algorithm, and multivariate analysis. Subsequently, the 3391 patients were classified into a train set and a test set in a 7:3 ratio. Utilizing the identified predictors, 3 predictive models were constructed using the logistic regression, support vector machine, and random forest algorithms. The ultimate model was selected based on the receiver operating characteristic (ROC) curve and TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) synthesis analysis. To further validate the model, we gathered prospective data from 600 patients with cancer at the Affiliated Hospital of Qinghai University and Hainan Provincial People's Hospital from June to December 2022. We assessed the model's performance using the area under the curve of the ROC to evaluate differentiation, the calibration curve for calibration capability, and decision curve analysis (DCA) to gauge the model's clinical applicability.

RESULTS

Independent risk factors for PICC-UE in patients with cancer were identified, including impaired physical mobility (odds ratio [OR] 2.775, 95% CI 1.951-3.946), diabetes (OR 1.754, 95% CI 1.134-2.712), surgical history (OR 1.734, 95% CI 1.313-2.290), elevated D-dimer concentration (OR 2.376, 95% CI 1.778-3.176), targeted therapy (OR 1.441, 95% CI 1.104-1.881), surgical treatment (OR 1.543, 95% CI 1.152-2.066), and more than 1 catheter puncture (OR 1.715, 95% CI 1.121-2.624). Protective factors were normal BMI (OR 0.449, 95% CI 0.342-0.590), polyurethane catheter material (OR 0.305, 95% CI 0.228-0.408), and valved catheter (OR 0.639, 95% CI 0.480-0.851). The TOPSIS synthesis analysis results showed that in the train set, the composite index (Ci) values were 0.00 for the logistic model, 0.82 for the support vector machine model, and 0.85 for the random forest model. In the test set, the Ci values were 0.00 for the logistic model, 1.00 for the support vector machine model, and 0.81 for the random forest model. The optimal model, constructed based on the support vector machine, was obtained and validated externally. The ROC curve, calibration curve, and DCA curve demonstrated that the model exhibited excellent accuracy, stability, generalizability, and clinical applicability.

CONCLUSIONS

In summary, this study identified 10 independent risk factors for PICC-UE in patients with cancer. The predictive model developed using the support vector machine algorithm demonstrated excellent clinical applicability and was validated externally, providing valuable support for the early prediction of PICC-UE in patients with cancer.

Clinical factors of PICC-RVT in cancer patients: a meta-analysis

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.

Risk factors associated with venous thromboembolism in breast cancer: a narrative review

PURPOSE

To date, there is no universally acceptable risk assessment tool in clinical practice that accurately estimates the risk of venous thromboembolism (VTE) in patients with breast cancer, despite the large number of published studies. Thus, the aim of this narrative review was to summarize the most relevant risk factors for VTE in these patients.

METHODS

We searched Ovid Embase and Ovid MEDLINE, from inception to March 26, 2021, to identify all articles that focused on breast cancer and multiple thromboembolic diseases. We also searched the references section of relevant articles to identify studies. We did not include case reports or case series with small sample size, N < 20.

RESULTS

VTE in patients with breast cancer was strongly associated with patient-, tumor-, and non-tumor-related risk factors, such as age, disease stage, central catheter placement, and chemotherapy and tamoxifen use, especially within 2 years of breast cancer diagnosis. CDK inhibitors are emerging factors that may also increase the risk of VTE.

CONCLUSIONS

The risk of VTE in patients with breast cancer depends on various patient-, tumor-, and non-tumor-related risk factors. Identifying these risk factors during breast cancer diagnosis and treatment is essential in developing a practical dynamic predictive tool that can help individualize strategies to prevent VTE.

A model to assess the risk of peripherally inserted central venous catheter-related thrombosis in patients with breast cancer: a retrospective cohort study

PURPOSE

Limited risk assessment tool to stratify the risk of PICC-related thrombosis (PICC-RVT) in breast cancer patients. This study developed a model to assess the risk of PICC-RVT in breast cancer patients.

METHODS

We conducted a retrospective cohort study of 1284 breast cancer patients receiving PICC insertion from January 1, 2015, to August 31, 2019, at a cancer specialized hospital in Hunan province, China. The entire population was divided into two groups at a ratio of 3:1 which included a derivation sample (n = 978), and a validation sample (n = 284). PICC-RVT was confirmed by ultrasonography in the presence of clinical symptoms and signs.

RESULTS

PICC-RVT occurred in 40 (4.09%) of the derivation sample patients. Multivariable analysis identified 9 variables: chronic obstructive pulmonary disease, prior central venous catheter placement, higher level of platelets, higher level of D-dimer, lower level of activated partial thromboplastin time, menopause, no prior breast surgery, upper extremity lymphedema, and endocrine therapy. Points were assigned to each variable according to regression coefficient. The model had an area under the receiver operating characteristics curve (AUC) of 0.850 (95% CI 0.776 to 0.924), The Hosmer-Lemeshow goodness-of-fit was 5.780 (p = 0.328). At a cutoff value of 3.5, the sensitivity and specificity were 75% and 83%, respectively.

CONCLUSION

Several disease-specific factors of breast cancer (e.g., menopause, endocrine therapy, and upper extremity lymphedema) play important roles in the development of PICC-RVT. Patients at higher PICC-RVT risk could be candidates for close post-insertion monitoring and interventions to prevent PICC-RVT.

Tailored approach to the choice of long-term vascular access in breast cancer patients

This study compared the possible options for vascular access in breast cancer patients by analyzing the complications of each method. We retrospectively evaluated the vascular access procedures for intravenous chemotherapy in breast cancer patients from 2016 to 2018. A total of 300 consecutive patients were included, 100 each who received peripherally inserted central catheters (PICCs), arm ports, and chest ports. When selecting a catheter, a PICC was considered when four cycles of chemotherapy were expected. Otherwise, patient preference was considered. All but one patient with an arm port were women, with mean age of 51.7 ± 9.1 years. The total mean complication-free catheter indwelling time was 1357.6 days for chest ports, 997.8 days for arm ports, and 366.8 days for PICCs (p = 0.004). There were 11 catheter-related complications (3.7%), one in a chest port patient, five in arm port patients, and eight in PICC patients. There was no patient with catheter related blood stream infection or deep vein thrombosis. All three types of catheters could be used in breast cancer patients without causing serious complications. The selection of catheter considering the clinical situation was effective for providing a safe and secure chemotherapy delivery route.

Validation of Michigan risk score and D-dimer to predict peripherally inserted central catheter-related thrombosis: A study of 206,132 catheter days

BACKGROUND

The Michigan Risk Score (MRS) was the only predicted score for peripherally inserted central venous catheters (PICC) associated upper extremity venous thrombosis (UEVT). Age-adjusted D-dimer increased the efficiency for UEVT. There were no external validations in an independent cohort.

METHOD

A retrospective study of adult patients with PICC insertion was performed. The primary objective was to evaluate the performance of the MRS and age-adjusted D-dimer in estimating risk of PICC-related symptomatic UEVT. The sensitivity, specificity and areas under the receiver operating characteristics (ROC) of MRS and age-adjusted D-dimer were calculated.

RESULTS

Two thousand one hundred sixty-three patients were included for a total of 206,132 catheter days. Fifty-six (2.6%) developed PICC-UEVT. The incidences of PICC-UEVT were 4.9% for class I, 7.5% for class II, 2.2% for class III, 0% for class IV of MRS (p = 0.011). The incidences of PICC-UEVT were 4.5% for D-dimer above the age-adjusted threshold and 1.5% for below the threshold (p = 0.001). The areas under ROC of MRS and age-adjusted D-dimer were 0.405 (95% confidence interval (CI) 0.303-0.508) and 0.639 (95% CI 0.547-0.731). The sensitivity and specificity of MRS were 0.82 (95% CI, 0.69-0.91), 0.09 (95% CI, 0.08-0.11), respectively. The sensitivity and specificity of age-adjusted D-dimer were 0.64 (95% CI, 0.46-0.79) and 0.64 (95% CI, 0.61-0.66), respectively.

CONCLUSIONS

MRS and age-adjusted D-dimer have low accuracy to predict PICC-UEVT. Further studies are needed.

Risk Factors of PICC-Related Venous Thrombosis in Breast Cancer Patients Undergoing Chemotherapy

Background

To analyze the risk factors of a peripherally inserted central catheter (PICC)-related venous thrombosis in patients with breast cancer undergoing chemotherapy and explore its preventive measures.

Methods

Data of 780 patients with breast cancer who underwent PICC chemotherapy in our hospital from January 2014 to June 2015 were retrospectively analyzed. The incidence of catheter-related thrombosis was observed, and related factors of venous thrombosis were analyzed.

Results

Among the 780 patients with breast cancer, 36 developed PICC-related venous thrombosis. The incidence of which was 4.62% (36/780). The PICC retention time ranged between 60 and 136 days, and the median time was 92 days. Thrombosis was found to occur within seven days after catheterization in three patients (8.33%), between 7 and 30 days in 18 patients (50%), between 31 and 92 days in 12 patients (33.3%), and ≥92 days in three patients (8.33%). Basilic vein puncture-induced thrombosis occurred in 25 patients (3.68%), and median cubital vein and cephalic vein puncture-induced thrombosis occurred in 11 patients (10.78%). The difference was statistically significant (P = 0.001). Thrombosis was not associated with age, punctured limb, platelet count, or chemotherapy drugs (P > 0.05).

Conclusion

Blood vessel puncture was the main factor that affected PICC-related thrombosis in breast cancer chemotherapy. The basilic vein should be the primary choice for blood vessel puncture. Prolonged catheter retention does not increase the risk of thrombosis.

Option of Using Peripherally Inserted Central Catheters in Elderly Patients With Dementia: An Observational Study

Background: Peripherally inserted central catheters (PICCs) facilitate the treatment of several diseases. Here, we assessed the clinical course of elderly patients with dementia using PICCs. Methods: This retrospective observational study was conducted at a single dementia treatment center. PICCs were used in elderly inpatients with dementia who required (a) intravenous therapy, supplemental parenteral nutrition, and dysphagia rehabilitation during acute illness; (b) end-of-life care; (c) total parenteral nutrition (TPN); or (d) an alternative to peripheral vascular (PV) access. Results: Fifty-nine patients were enrolled (83.5 ± 6.9 years): 61% were in the acute treatment group, and 17% were in the end-of-life care group. The median catheter lifespan was 42 (23-87.5) days. The incidence of catheter-related bloodstream infection was 0.22 per 1,000 PICC-days, and that of deep venous thrombosis was 0.66 per 1,000 PICC-days. Among the patients in acute treatment group, 19% resumed sufficient oral intake after the treatment using PICC, and 36% resumed oral intake of gelatin-like food. Among the patients in the end-of-life care group, 91% received intravenous fluids continuously until death by initially inserted PICC. Conclusion: In elderly patients with dementia, PICCs might be one of the options during the treatment of acute illness as well as for prolonged support during end-of-life care.

The anticoagulants rivaroxaban and low molecular weight heparin prevent PICC-related upper extremity venous thrombosis in cancer patients

Peripherally inserted central catheter (PICC) is often applied in chemotherapy patients and commonly causes upper extremity venous thrombosis (UEVT), which should be prevented.To assess the preventive effects of the anticoagulants rivaroxaban and low molecular weight heparin (LMWH) on UEVT in patients receiving chemotherapy through PICCs.A total of 423 chemotherapy patients with continuous PICC use between January 2014 and June 2015 at the Oncology Department of Dongying People's Hospital were divided into 3 groups: rivaroxaban (10 mg/day, orally), LMWH (Enoxaparine, 4000 anti-Xa IU/day, subcutaneous injection), and control (no anticoagulant). UEVT incidence and other complications during PICC use were observed and recorded.The rivaroxaban, LMWH, and control groups included 138 (79 males; 54.9 ± 11.0 years), 144 (76 males; 56.0 ± 10.9 years), and 141 (71 males; 53.3 ± 10.9 years) patients, (P = .402 and P = .623 for age and sex respectively). There were no differences in cancer location (P = .628), PICC implantation site (P > .05), body mass index (BMI) (P = .434), blood pressure (all P > .05), blood lipids (5 laboratory parameters included, all P > .5), smoking (P = .138), history of lower limb venous thrombosis (P = .082), and 10 other associated comorbidities (all P > .5). Twenty-nine patients withdrew from the study (5 from the rivaroxaban, 12 from the LMWH, and 12 from the control groups, respectively), and 394 patients were analyzed. There were significant differences in the rivaroxaban group and the LMWH group compared to the control group (P = .010 and P = .009, respectively), but no significant difference was observed between the rivaroxaban group and the LMWH group (P = .743).Anticoagulants such as rivaroxaban and LMWH may reduce the incidence of PICC-related UEVT in patients receiving chemotherapy.

Two successful insertions of peripherally inserted central catheters in a patient with persistent left superior vena cava: A case report

RATIONALE

Peripherally inserted central catheters (PICC), normally located at the lower 1/3rd of the superior vena cava (SVC) and cavo-atrial junction, are commonly used in cancer patients. Persistent left superior vena cava (PLSVC) is a vascular anomaly, in patients with which seldom research was reported about PICC implanted. After obtaining written informed consent, we present a case where two successful insertions of PICC were performed in a 50-year-old female patient with PLSVC and right SVC.

PATIENTS CONCERNS

The patient had ovarian cancer and was admitted for chemotherapy using PICC.

DIAGNOSES

Ovarian cancer and PLSVC.

INTERVENTIONS AND OUTCOMES

Following insertion of PICC in PLSVC, thrombosis developed. PICC was removed after routine anticoagulation therapy. Owing to tumor recurrence, a second PICC was inserted in the right SVC without any complications.

LESSONS

PICC insertion in PLSVC for chemotherapy may be associated with an increased risk of deep venous thrombosis of the upper extremity. A right catheter insertion in patient with PLSVC was preferred.

The legacy of lymphedema: Impact on nursing practice and vascular access

Breast cancer is the most common cancer in women. Breast cancer related lymphedema (BCRL) is a chronic condition characterized by an abnormal accumulation of protein-rich fluid in tissues resulting in swelling of the upper limb or trunk after treatment. Lack of consensus on definition, classification and grading of BCRL has led to subjective and objective parameters estimating incidence and severity. Prospective studies estimate the risk of BCRL to be approximately 21.4% (14.9-29.8). In patients with axillary lymph node dissection (ALND), the estimated risk of 19% (13.5-28.2) was about four times higher than those patients who had sentinel lymph node biopsy (5.6%, 6.1-7.9). Seventy percent of these patients will experience BCRL within two years of surgery, 90% within three years, and a 1% rate per year thereafter. Many patients who have no high-risk variables such as mastectomy, ALND and radiation therapy develop BCRL. Patients fear this complication, which has no cure and no proven prevention strategies. Risk reduction strategies, primarily focused on reducing trauma to the surgical arm, are based on anecdotal information and effectively restrict the use of the at-risk limb for the patient's lifetime. Although broad risk reduction strategies have been recommended, the avoidance of needle sticks has become the most common strategy practised, enforced through institutional policies and procedures and reinforced through patient education initiatives and breast cancer support groups. Large cohort studies have found no significant association between blood draws and intravenous infusions in the surgical arm and the development of BCRL. Current literature supports that approximately 21% of patients will develop BCRL, leaving 79% free of the complication. Due to increased survival, breast cancer survivors go on to develop other healthcare issues that may require vascular access. Therefore, long-held beliefs with regards to risk factors and preventative measures need to be challenged. Education of healthcare providers, patients and support groups through the dissemination of evidence-based information on the diagnosis, prevention and treatment of BCRL is necessary to ensure that patients receive the best care possible with the least risk.

Risk factors associated with peripherally inserted central catheter-related venous thrombosis in hospitalized patients of advanced age

Objective

This study was performed to determine the risk factors associated with peripherally inserted central catheter (PICC)-related venous thrombosis in patients of advanced age (>65 years).

Methods

In total, 549 hospitalized patients aged 66 to 104 years who were undergoing PICC placement from January 2008 to December 2014 were enrolled. Symptomatic venous thrombosis was confirmed by B-mode or Doppler ultrasonography in the presence of clinical signs. Logistic regression analysis was performed on the variables of interest to identify the risk factors for thrombosis. Odds ratios (ORs) with the corresponding 95% confidence intervals were generated.

Results

Of the 549 patients with PICC placement, 106 (19.3%) developed PICC-associated venous thrombosis, 84 cases of which were symptomatic. The logistic regression results revealed that PICC-related venous thrombosis was associated with a history of venous thrombosis (OR, 6.745 [3.237–14.056]), number of lumens (OR, 1.934 [1.362–2.572] and OR, 3.762 [1.672–5.932] for dual and triple lumens, respectively), and PICC gauge (OR, 1.821 [1.256–2.537] and OR, 3.864 [1.367–8.251] for 5-Fr and 6-Fr, respectively).

Conclusions

A history of thrombosis, high number of lumens, and large-gauge catheters were strong risk factors for patients aged >65 years undergoing PICC placement.

Does Hyperglycemia Affect Risk of Peripherally Inserted Central Catheter-Related Upper Extremity Venous Thrombosis?

It is not clear whether blood glucose (BG) affects the risk of peripherally inserted central catheter (PICC)-related upper extremity venous thrombosis (PRUEVT). A case-control study was conducted comparing patients with PRUEVT versus patients with PICCs who did not develop PRUEVT. BG on admission was significantly higher among cases with PRUEVT than controls. No significant differences were found between the groups in hemoglobin A1c or BG on the third day of hospitalization. PRUEVT cases were more likely to be diabetic, but this did not reach statistical significance. The time that a PICC was in place before PRUEVT was diagnosed was longer for diabetic patients, but the authors believe this result must be viewed with caution.

Upper extremity deep vein thrombosis after migration of peripherally inserted central catheter (PICC): A case report

INTRODUCTION

Peripherally inserted central venous catheters (PICC) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate. The tip position of the catheter should be located at the border of lower one-third of the superior vena cava (SVC) and cavo-atrial junction. The migration is malposition at the late stage after PICCs were inserted, and catheter malposition was associated with thrombosis and other complications.After patient's informed consent, we report a case of a 66-year-old male with twice catheter migrations resulting in thrombosis after being diagnosed with cardiac cancer.

CONCLUSION

The correct position of the catheter tip can ensure the normal use of PICC and reduce the complications. For the migrated catheter, it should be removed as soon as possible, and when thrombosis has been developed, standard anticoagulant therapy should be given.

Peripherally inserted central catheter-related complications in cancer patients: a prospective study of over 50,000 catheter days

Purpose

To evaluate incidence and risk factors of peripherally inserted central catheter (PICC)-related complications in cancer patients.

Methods

A prospective, multicenter, cohort study of cancer patients with PICC insertion was performed from February 1, 2013 to April 24, 2014. All patients were monitored in clinic until PICCs were removed. The primary endpoint was PICC removal due to complications. Patient-, catheter- and insertion-related factors were analyzed in univariable and multivariable logistic regression analysis to identify significant independent risk factors for PICC-related complications.

Results

There were 477 cancer patients included, for a total of 50,841 catheter-days. Eighty-one patients (17.0%) developed PICC-related complications, with an incidence of 1.59 per 1000 catheter days. Thirty-six (7.5%) PICCs were removed because of complications. The most common complications were skin allergy (4.6%), catheter occlusion (3.4%) and accidental withdrawal (2.3%). Nine (1.9%) patients developed symptomatic upper extremity deep venous thrombosis (UEDVT) and central line associated bloodstream infection (CLABSI) was shown in six (1.3%) PICCs with an infection rate 0.12 per 1000 catheter days. In multivariable analysis, body mass index (BMI) >25 (odds ratio, 2.09; 95% confidence interval, 1.26-3.47, p = 0.004) was shown to be a significant risk factor for PICC complications.

Conclusions

Cancer patients with BMI greater than 25 were more likely to have PICC complications.

Health-Related Quality of Life of Cancer Patients with Peripherally Inserted Central Catheter: A Pilot Study

Introduction

This pilot exploratory study aimed to compare the health-related quality of life (HRQOL) among patients diagnosed with different types of cancer receiving peripherally inserted central catheters (PICCs).

Methods

A multicenter cross-section study of cancer patients with PICCs was performed from February 1, 2013 to April 24, 2014. The primary objective of this study was to compare HRQOL in different cancer type patients with PICC. HRQOL was examined based on European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (EORTC QLQ-C30). Multiple linear regression models were conducted for coping with potential confounding variables. We also examined PICC-related quality of daily life with a self-made questionnaire.

Results

Three hundred and fifty-seven cancer patients with PICC completed the survey in nine teaching hospitals. Lung cancer patients with PICC reported the worst dyspnea. Digestive tract cancer patients reported the worst appetite loss. Patients with hematologic malignancy reported the worst emotional, social function, fatigue and financial impact. Breast cancer patients reported better HRQOL. Baseline variables were proven not significant predictors of EORTC QLQ-C30 global health status. In self-made survey, pain after PICC insertion was null or a little in 98.6% of cancer patients. Limitation of upper extremity activity was null or a little in 94.1% of patients.

Conclusions

HRQOL varies in different types of cancer patients with PICC. PICC may have a low impact on cancer patients’ HRQOL. Further large sample studies are needed.

Two successful insertions of peripherally inserted central catheter in a super elderly patient with bilateral pacemaker placement

Peripherally inserted central catheters (PICCs) have been placed through the peripheral veins, and the best location for the tip of the PICCs is the lower third of the superior vena cava (SVC) and cavo-atrial junction. PICCs are commonly used in intravenous administration, parenteral nutrition therapy, chemotherapy, as well as in critical care units. The success rates in venipuncture are enhanced when ultrasonographic guides are used by the bedside PICC teams. There have been few reports of PICCs placed in super elderly patients with permanent cardiac pacemakers. We share a case of two successful PICC insertions in a 97-year-old patient with bilateral pacemaker placement, that have not been reported previously.