Cancer care

PICC standard will avoid unnecessary thrombosis risk for cancer patients


Adherence to a catheter-vein ratio cut-off will help avoid thrombosis in cancer patients receiving IV therapy, Australian findings suggest.

A catheter-vein ratio (CVR) should not exceed 45% to minimise the risk of thrombosis in cancer patients requiring a peripherally inserted central catheter (PICC) insertion, according to researchers from the University of South Australia.

A retrospective study of 2,438 PICC insertions in adult patients across four hospitals in Australia and New Zealand has found 1.6% were associated with thrombosis.

The study, published in BMJ Open, found patients with a cancer diagnosis had three times the risk of thrombosis than those with an infection as an underlying diagnosis.

Overall, a CVR cut-off of 45% was predictive of thrombosis risk, with those with a higher ratio having more than twice the risk of thrombus (RR 2.30; 95% CI 1.202 to 4.383; p=0.01).

Similarly in only cancer patients, a CVR above the 45% cut-off was associated with twice the risk of thrombosis (RR 2.10; 95% CI 1.055 to 4.177; p=0.035).

The analysis in patients with infection and other non-malignant conditions was limited by the low numbers of thromboses in this group.

“The results from the present study suggest that the use of a CVR≤45% is an important component in the strategies used during PICC insertion to reduce the risk of thrombosis in individuals with cancer requiring a PICC,” the study said.

“Factors such as the selection of an appropriate sized vein are especially important in the cancer patient cohort as larger, multi-lumen PICCs may be required which exacerbates thrombosis risk.”

The investigators, led by Dr Rebecca Sharp from the University of South Australia’s Rosemary Bryant AO Research Centre, said their findings support the use of a 45% CVR cut-off as advocated in the Infusion Nurses Society clinical guidelines.

“Further research is required to determine PICC associated thrombosis risk according to cancer type generally and may consider investigating risk according to specific diagnosis,” they said.

“A more nuanced understanding of the risk of PICC associated thrombosis for individual consumers would allow clinicians to provide targeted interventions for those most at risk.”

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