The Incidence, Risk Factors, and Patterns of Peripherally Inserted Central Catheter-Related Venous Thrombosis in Cancer Patients Followed Up by Ultrasound

Figures & data

Table 1 Univariate Analysis of Clinical, Vascular and Technical Characteristics of Patients with and without PICC-Related VTE

Variables	VTE Group (n = 165)	Normal Group (n = 2188)	P
Clinical characteristics
Sex (%)			0.713
Male	75 (45.5)	1027 (46.9)
Female	90 (54.5)	1161 (53.1)
Age, years	53±13	52±14	0.426
BMI, kg/m^2	24.6±3.9	24.1±3.7	0.114
BMI grading (%)			0.017
≤25 kg/m^2	88 (53.3)	1371 (62.7)
>25 kg/m^2	77 (46.7)	817 (37.3)
Arm circumference, cm	27.2±3.0	26.6±3.0	0.006
Diabetes mellitus (%)	15 (9.1)	211 (9.6)	0.816
Hypertension (%)	35 (21.2)	423 (19.3)	0.557
Tobacco smoking (%)	37 (22.4)	461 (21.1)	0.681
Alcohol consumption (%)	17 (26.2)	260 (11.9)	0.533
Previous VTE (%)	11 (6.7)	109 (5.0)	0.343
Symptoms (%)			–
Swelling	58 (35.1)	58 (2.7)
Pain or ache	26 (15.8)	–
Cyanosis of the skin	4 (2.4)	–
Total	88 (53.3)	58 (2.7)	<0.001
Laboratory indices
ABO blood group (%)			<0.001
O	28 (16.9)	656 (30.0)
A	44 (26.7)	577 (26.4)
B	63 (38.2)	730 (33.3)
AB	30 (18.2)	225 (10.3)
Triglycerides (%)			0.011
Normal	100 (60.6)	1533 (70.1)
High	65 (39.4)	655 (29.9)
LDL-C (%)			0.238
Normal	112 (67.9)	1579 (72.1)
High	53 (32.1)	609 (27.8)
Total cholesterol (%)			0.426
Normal	140 (84.8)	1904 (87.0)
High	25 (15.2)	284 (13.0)
White cell count, ×10^9/L	6.3±2.6	6.8±4.4	0.153
Platelet count, ×10^9/L	235.9±89.0	232.93±85.7	0.691
APTT, s	30.0±5.0	32.7±6.5	<0.001

Abbreviations: APTT, activated partial thromboplastin time; BMI, body mass index; LDL-C, low-density lipoprotein cholesterol; PICC, peripherally inserted central catheter; VTE, venous thromboembolism.

Table 2 Univariate Analysis of Vascular and Technical Characteristics of Patients with and without PICC-Related VTE

Variables	VTE Group (n = 165)	Normal Group (n = 2188)	P
Vascular level
Vein depth, mm	8.7±3.9	8.5±3.5	0.467
Vein diameter, mm	0.39±0.07	0.41±0.08	0.001
Subgroup of vein diameter (%)			0.019
≤0.40 mm	104 (63)	1173 (53.6)
>0.40 mm	61 (37)	1015 (46.4)
Ratio of diameter ^†	0.35±0.06	0.33±0.06	<0.001
Subgroup of ratio of diameter (%)			0.004
≤0.35	85 (51.5)	1375 (62.8)
>0.35	80 (48.5)	813 (37.2)
PICC placement
Indwelling time, days^&	72 (32, 143)	131 (83, 182)	<0.001
Thrombosis time, days^&	12 (8, 27)	–	–
Insertion attempts >1 (%)	10 (6.1)	113 (5.2)	0.618
Insertion arm (%)			0.402
Left	50 (30.3)	597 (27.3)
Right	115 (69.7)	1591 (72.7)
Insertion vein (%)			0.133^a
Basilic	140 (84.8)	1832 (83.7)
Brachial	18 (10.9)	309 (14.1)
Cephalic	7 (4.3)	47 (2.2)

Notes: ^aRepresents the P value was analyzed by Fisher exact test. ^&Represents a non-distributional data described as median (P₂₅, P₇₅) and compared by Mann–Whitney rank sum test. ^†The ratio of diameter represents the ratio of the PICC:vein diameter.

Abbreviations: APTT, activated partial thromboplastin time; PICC, peripherally inserted central catheter; VTE, venous thromboembolism.

Figure 1 Flowchart showing the final study cohort.

Figure 2 The cumulative incidence of PICC-related VTE. The blue line denotes total incidence of PICC-related VTE; the purple line denotes incidence of isolated SVT; the yellow line denotes incidence of SVT combined with DVT.

Table 3 Multivariable Logistic Regression of Risk Factors Related to PICC-Related Venous Thromboembolism

Variables	OR	95% CI	P	Adjusted OR	95% CI	P
BMI >25kg/m^2	1.550	1.117–2.150	0.009	1.222	0.780–1.915	0.382
ABO blood group
O	Reference	Reference	–	Reference	Reference	–
A	1.814	1.113–2.958	0.017	1.680	1.009–2.798	0.046
B	2.030	1.283–3.213	0.003	1.835	1.137–2.961	0.013
AB	3.108	1.811–5.333	<0.001	3.275	1.840–5.829	<0.001
Ratio of diameter >0.35 mm	1.385	0.854–2.245	0.187	1.689	1.023–2.789	0.041
Vein diameter >0.4 mm	0.824	0.504–1.349	0.442	0.709	0.424–1.186	0.191
High level of triglycerides	1.362	0.973–1.906	0.071	1.561	1.096–2.223	0.014

Notes: ORs were derived from multivariate logistic regression analysis after adjusting the factors of APTT and arm circumstance.

Abbreviations: BMI, body mass index; CI, confidence interval; OR, odd ratio; PICC, peripherally inserted central catheter.

Figure 3 Forest plot showing the adjusted odd ratios for risk factors of PICC-related VTE. PICC, peripherally inserted central catheter; VTE, venous thromboembolism.

Table 4 Multivariable Analysis of Related Variables in SVT and SVT+DVT Groups

Variables	SVT Group (n = 59)	SVT+DVT Group (n = 106)	OR	95% CI	P
Sex (%)
Male	25 (42.4)	50 (47.2)	Reference	Reference
Female	34 (57.6)	56 (52.8)	1.150	0.326–4.053	0.828
Age, years	52±14	54±13	1.002	0.965–1.041	0.909
BMI >25kg/m^2 (%)	23 (39.0)	54 (50.9)	1.679	0.441–6.395	0.448
ABO blood group (%)
O	10 (17.0)	18 (17.0)	Reference	Reference
A	16 (27.1)	28 (26.4)	0.559	0.122–2.557	0.454
B	21 (35.6)	42 (39.6)	1.236	0.297–5.133	0.771
AB	12 (20.3)	18 (17.0)	0.771	0.156–3.817	0.750
APTT, s	31.7±5.1	29.1±4.7	0.868	0.778–0.968	0.011
Indwelling time, days^a	106 (69, 136)	50 (32, 149)	0.981	0.970–0.992	<0.001
Thrombosis time, days^a	11 (6, 14)	12 (8, 33)	1.031	1.013–1.050	0.001
Arm circumference, cm	26.3±3.0	27.8±2.9	1.371	1.035–1.816	0.028
Symptomatic thrombosis (%)
Swelling	5 (8.5)	48 (45.3)
Pain or ache	14 (23.7)	17 (16.0)
Cyanosis of the skin	2 (3.4)	2 (1.9)
Total	21 (35.6)	67 (63.2)	3.109	1.602–6.034	0.001
Vein diameter, mm	0.39±0.07	0.39±0.08	2.072	0.026–168.163	0.745
Vein diameter >0.4mm (%)	21 (35.6)	40 (37.7)	0.833	0.126–5.518	0.850
Ratio of diameter^†	0.35±0.06	0.35±0.06	0.777	0.004–166.512	0.927
Ratio of diameter >0.35 (%)	30 (50.8)	50 (47.2)	0.680	0.106–4.350	0.684
Depth, mm	8.7±3.8	8.7±4.0	0.324	0.060–1.742	0.189
Status of vein (%)
Partial occlusion	5 (8.5)	52 (49.1)	Reference	Reference
Total occlusion	54 (91.5)	54 (50.9)	0.158	0.039–0.649	0.010
Pulmonary embolism (%)	0	1 (0.9)	–	–	–
Recanalization (%)	9 (15.3)	65 (61.3)	17.942	5.427–59.316	<0.001
Recanalization time, days	18±4	20±5	0.186	–	–

Notes: ^aRepresents a non-distributional data described as median (P₂₅, P₇₅). ^†The ratio of diameter represents the ratio of the PICC:vein diameter.

Abbreviations: APTT, activated partial thromboplastin time; CI, confidence interval; DVT, deep venous thrombosis; OR, odd ratio; PICC, peripherally inserted central catheter; SVT, superficial venous thrombosis.

Figure 4 Ultrasound examination of PICC-related VTE. (A–C) show that the basilic vein with PICC-related superficial venous thrombosis was completely occluded and uncompressed without any color signal after 2 weeks of anticoagulation therapy. (D–F) show that the subclavian vein with PICC-related deep venous thrombosis was partially occluded, but was recanalized and filling with blood flow after 2 weeks of anticoagulation therapy.

Figure 5 The recanalization time of PICC-related VTE. The blue line denotes all patients with VTE; the purple line denotes the SVT group; the yellow line denotes the SVT+DVT group.