Risk of VTE associated with PORTs and PICCs in cancer patients: A systematic review and meta-analysis

Wang, Pengpeng; Soh, Kim Lam; Ying, Yanping; Liu, Yuanhang; Huang, Xueling; Huang, Jinlan

doi:10.1016/j.thromres.2022.02.024

Cited by 23 publications

(16 citation statements)

References 51 publications

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“…Additionally, consistent with previous reports, we found that cancer, 24 prior VTE, 24 immobilization, 24 an indwelling PICC line or infusion port, 32 surgery or trauma, 24 thrombocytosis, 31 anemia, 29 , 30 thrombophilia, 24 Black race, 37 recent major hemorrhage, 36 obesity, 24 male sex, 38 and acute infection were associated with HA-VTE risk. 24 In addition, we found in this study that the automatically captured illness severity indices COPS and LAPS 35 were associated with HA-VTE.…”

Section: Discussionsupporting

confidence: 92%

“…We defined 23 potential risk factors associated with HA-VTE based on prior studies, which were adapted to be used with retrospective EHR data. These included the 11 elements of the Padua Predictive Score, 24 as well as 12 additional previously identified risk factors 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 : active cancer, previous VTE, bed rest or immobilization, thrombophilia, recent trauma or surgery, age 70 years or older, current admission for heart or respiratory failure, current admission for ischemic stroke, acute infection, body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or more, ongoing hormonal treatment, being an active tobacco smoker, poorly controlled diabetes (ie, hemoglobin A 1c ≥10.0% [to convert to proportion of total hemoglobin, multiply by 0.01]), low hemoglobin level (ie, <10.0 g/dL [to convert to grams per liter, multiply by 10.0]), high platelet count (ie, ≥500 ×10 3 /uL [to convert to ×10 9 per liter, multiply by 1.0]), presence of an infusion port or a peripherally inserted central (PICC) line, recent use of a serotonergic antidepressant, microalbuminuria, high illness severity index scores 39 (Comorbidity Point Score [COPS] ≥50 and Laboratory Acute Physiology Score [LAPS] ≥100) at time of admission, recent major hemorrhage (within 30 days prior to admission), race and ethnicity, requirement for language interpreter, and male sex. In addition, a covariate of pharmacological VTE prophylaxis in the first 48 hours after admission was defined based on completed medication orders (eAppendix in the Supplement ).…”

Section: Methodsmentioning

confidence: 99%

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Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

et al. 2022

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ImportanceWhile hospital-associated venous thromboembolism (HA-VTE) is a known complication of hospitalization, contemporary incidence and outcomes data are scarce and methodologically contested.ObjectiveTo define and validate an automated electronic health record (EHR)–based algorithm for retrospective detection of HA-VTE and examine contemporary HA-VTE incidence, previously reported risk factors, and outcomes.Design, Setting, and ParticipantsThis cohort study was conducted using hospital admissions between January 1, 2013, and June 30, 2021, with follow-up until December 31, 2021. All medical (non–intensive care unit) admissions at an integrated health care delivery system with 21 hospitals in Northern California during the study period were included. Data were analyzed from January to June 2022.ExposuresPreviously reported risk factors associated with HA-VTE and administration of pharmacological prophylaxis were evaluated as factors associated with HA-VTE.Main Outcomes and MeasuresYearly incidence rates and timing of HA-VTE events overall and by subtype (deep vein thrombosis, pulmonary embolism, both, or unknown), as well as readmissions and mortality rates.ResultsAmong 1 112 014 hospitalizations involving 529 492 patients (268 797 [50.8%] women; 75 238 Asian [14.2%], 52 697 Black [10.0%], 79 398 Hispanic [15.0%], and 307 439 non-Hispanic White [58.1%]; median [IQR] age, 67.0 [54.0-79.0] years), there were 13 843 HA-VTE events (1.2% of admissions) occurring in 10 410 patients (2.0%). HA-VTE events increased from 307 of 29 095 hospitalizations (1.1%) in the first quarter of 2013 to 551 of 33 729 hospitalizations (1.6%) in the first quarter of 2021. Among all HA-VTE events, 10 746 events (77.6%) were first noted after discharge. In multivariable analyses, several factors were associated with increased odds of HA-VTE, including active cancer (adjusted odds ratio [aOR], 1.96; 95% CI, 1.85-2.08), prior VTE (aOR, 1.71; 95% CI, 1.63-1.79), and reduced mobility (aOR, 1.63; 95% CI, 1.50-1.77). Factors associated with decreased likelihood of HA-VTE included Asian race (vs non-Hispanic White: aOR, 0.65; 95% CI, 0.61-0.69), current admission for suspected stroke (aOR, 0.73; 95% CI, 0.65-0.81), and Hispanic ethnicity (vs non-Hispanic White: aOR, 0.81; 95% CI, 0.77-0.86). HA-VTE events were associated with increased risk of readmission (hazard ratio [HR], 3.33; 95% CI, 3.25-3.41) and mortality (HR, 1.63; 95% CI, 1.57-1.70).Conclusions and RelevanceThis study found that HA-VTE events occurred in 1.2% of medical admissions, increased over time, and were associated with increased adverse outcomes. These findings suggest that approaches designed to mitigate occurrence and outcomes associated with HA-VTE may remain needed.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

et al. 2022

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“…Introduced as a lower risk alternative to non-tunneled central venous access devices, PICCs may lead to venous thrombosis, occlusion, and bloodstream infection [1][2][3][4][5][6][7][8]. Prior to the implementation of MAGIC in late 2015, variation in PICC practices was common and discordant with clinical guidelines [19,[35][36][37].…”

Section: Discussionmentioning

confidence: 99%

“…Peripherally inserted central catheters (PICCs) enable delivery of intravenous (IV) therapy while providing safe, reliable access for blood draws. Despite their benefits, PICCs are associated with complications, including thromboembolism and bloodstream infection [1][2][3][4][5][6][7][8]. Complications delay treatment and increase length of stay and financial burden for healthcare systems [9].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for implementing peripherally inserted central catheter (PICC) appropriateness guidelines: A longitudinal survey study from 34 Michigan hospitals

et al. 2022

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Peripherally inserted central catheters (PICCs) are prevalent devices for medium-to-long-term intravenous therapy but are often associated with morbid and potentially lethal complications. This multi-center study sought to identify barriers and facilitators of implementing evidence-based appropriateness criteria to improve PICC safety and patient outcomes in a pay-for-performance model. Participating hospitals received an online toolkit with five recommendations: establishing a vascular access committee; implementing a clinical decision tool for PICC appropriateness; avoiding short-term PICC use (≤5 days); increasing use of single-lumen PICCs; and avoiding PICC placement in patients with chronic kidney disease. Longitudinal online surveys conducted biannually October 2014–November 2018 tracked implementation efforts. A total of 306 unique surveys from 34 hospitals were completed. The proportion of hospitals with a dedicated committee overseeing PICC appropriateness increased from 53% to 97%. Overall, 94% of hospitals implemented an initiative to reduce short-term and multi-lumen PICC use, and 91% integrated kidney function into PICC placement decisions. Barriers to implementation included: achieving agreement from diverse disciplines, competing hospital priorities, and delays in modifying electronic systems to enable appropriate PICC ordering. Provision of quarterly benchmarking reports, a decision algorithm, access to an online toolkit, and presence of local champion support were cited as crucial in improving practice. Structured quality improvement efforts including a multidisciplinary vascular access committee, clear targets, local champions, and support from an online education toolkit have led to sustained PICC appropriateness and improved patient safety.

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“…Nonetheless, severe complications can be caused by PICC insertion, including deep vein thrombosis, catheter-related endothelial damage, bloodstream infection and skin injury ( 5 , 6 ). Among these, peripherally inserted central catheter-related thrombosis (PICC-RT) is the most common and dangerous complication ( 7 , 8 ). This might result in a series of adverse consequences and induce the interruption of chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Benefits of an online multimodal nursing program among patients with peripherally inserted central catheter-related thrombosis

Huang

Xie²,

Zhao³

et al. 2022

Front. Public Health

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BackgroundAsymptomatic peripherally inserted central catheter-related thrombosis (PICC-RT) is one of the most common and dangerous complications caused by peripherally inserted central catheter (PICC) insertion. A variety of factors might lead to huge psychological pressures on patients and markedly affect their quality of life. The aim of this study was to evaluate the benefits of an online multimodal nursing program on the quality of life and psychological resilience of asymptomatic PICC-RT patients with ovarian cancer.MethodsThis was a prospective cohort study on patients with asymptomatic PICC-RT. Patients in the control group received routine nursing care, while patients in the intervention group obtained extra assistance through an online multimodal nursing program. Individual guidance, psychological support, and real-time consultation were provided to patients in the intervention group. All participants were followed for 3 months. The health-related quality of life and psychological resilience of patients were evaluated by using the 36-item Short Form Health Survey (SF-36) and Connor-Davidson Resilience Scale (CD-RISC), respectively.ResultsCompared to baseline, most of the items in the SF-36 scores were significantly increased in both intervention and control groups after 3 months (all p < 0.05), except for the role emotional domain (p = 0.085 in control group). However, the SF-36 scores of the intervention group were significantly higher than those of the control group in All health domains, including physical functioning (p = 0.001), role physical (p = 0.004), bodily pain (p = 0.003), general health (p < 0.001), vitality (p < 0.001), social functioning (p < 0.001), role emotional (p = 0.002), mental health (p < 0.001) and health transition (p < 0.001). For CD-RISC scores, the mean value of the control group was 42.03 ± 4.42 at baseline and increased to 50.36 ± 4.70 after 3 months (p < 0.001), while the intervention group was 40.00 ± 6.61 at baseline and increased to 65.12 ± 5.21 after 3 months (p < 0.001). Moreover, the CD-RISC score in the intervention group was significantly higher than that in the control group after 3 months (p < 0.001).ConclusionThe application of an online multimodal nursing program could significantly improve the health-related quality of life and psychological resilience of asymptomatic PICC-RT patients. These findings provide evidence to support the necessity of an online multimodal nursing program in routine long-term follow-up, especially in the era of COVID-19.

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Risk of VTE associated with PORTs and PICCs in cancer patients: A systematic review and meta-analysis

Cited by 23 publications

References 51 publications

Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

Barriers and facilitators for implementing peripherally inserted central catheter (PICC) appropriateness guidelines: A longitudinal survey study from 34 Michigan hospitals

Benefits of an online multimodal nursing program among patients with peripherally inserted central catheter-related thrombosis

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