Coagulation

PICC line thrombosis a challenge for adult oncology patients


Peripherally inserted central catheter (PICC) lines have again been shown to be associated with a higher rate of catheter-related thrombosis (CRT) than traditional central venous catheters (CVCs). 

A study of almost 5,000 central lines inserted in over 3,000 patients with haematological or solid cancers in a Brisbane hospital found that PICCs were associated with a Hazard Ratio (HR) of 22.2 compared to implanted ports.

The findings are consistent with recent US data on catheter-related thrombosis in children, as previously reported in the limbic

In the Australian study, 72.4% of lines were PICCs, 12.9% were non-tunnelled CVCs, 10.6% were tunnelled CVCs and 4.1% were implanted ports. Median line durations were highly variable – 43 days, 4 days, 22 days and 499 days respectively.  

The main indication for line insertion was for administration of chemotherapy (78.1%), followed by stem cell collection (10.8%) and stem cell reinfusion (6.7%).

The overall rate of catheter-related thrombosis was 3.6%, rising to 4.9% in PICCs. Catheter-related thrombosis typically developed within 12 days of line insertion.

Younger age (<50 years)  and prior catheter-related thrombosis were associated with increased risk of catheter-related thrombosis.

The study investigators, led by haematologist and PhD candidate Dr Marc Ellis, said: “the risk of CRT is relatively unique to PICC lines.”

“The reasons for such a low incidence in the internal jugular route most likely relate to a combination of factors, including a much shorter intravascular course, larger luminal diameter of the punctured vein and universal insertion in an interventional radiology facility plus fluoroscopic confirmation of tip location.”

Speaking to the limbic, Dr Ellis from the Heart Research Institute in Sydney said PICCs were obviously very popular. 

“PICCs are going to continue to be used and I don’t really see how we can mitigate the risk of the clots associated with them unless we can figure out a way to make them less thrombogenic.”

He said one option that probably needs to be explored further was the use of non-thrombogenic coatings. 

The study found that tumour type as defined by Khorana score and side of insertion were not significant predictors or thrombosis. However it found that patients with germ cell tumours had the highest rates of catheter-related thrombosis at 6.1%.

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