Peripherally Inserted Central Venous Catheter in Upper Extremities Could be a Risk for Deep Vein Thrombosis in Lower Extremities and D-Dimer in Neurology Department

2020 ◽  
Author(s):  
Wanli Liu ◽  
Lianxiang He ◽  
Wenjing Zeng ◽  
Liqing Yue ◽  
Jie Wei ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Predictive Value ◽  
Color Doppler ◽  
Venous Catheter ◽  
Upper Extremities ◽  
Central Venous ◽  
Related Factors ◽  
D Dimer

Abstract Background: With the in-depth study of Peripherally Inserted Central venous Catheter (PICC) related venous thrombosis, it is found that the incidence of lower extremity deep venous thrombosis (LEDVT) in patients with PICC in upper extremities is higher than that in patients without PICC . However, there is no explanation for this clinical phenomenon that PICC related venous thrombosis seems to have exceeded the range of PICC travel . The purpose of this study is to elucidate this association between PICC in upper extremities and LEDVT by observing the changes of D-dimer . Methods: This was a retrospective cohort study of adults in Neurology department who underwent Color Doppler ultrasound and D-dimer test between 1 April 2017 to 1 April 2020. We analyzed the related factors of LEDVT and the change of D-dimer value, compared the changes of D-dimer before and after PICC insertion, and evaluated the predictive value of D-dimer in patients with and without PICC. Results: ① It was found that the presence of PICC increased the risk of lower extremity venous thrombosis by 7 times (OR = 7.048 [95% CI: 4.486-11.074]; ②It was found that the presence of PICC promoted the increase of D-dimer value (OR = 5.133 [95% CI: 3.072-8.575]). ③ For patients without LEDVT, the level of D-dimer in patients with PICC was higher than that in patients without PICC (P < 0.05). ④ The level of D-dimer after PICC insertion was significantly higher than that before PICC insertion(P < 0.05). ⑤ In patients with PICC, the AUC value of D-dimer in the diagnosis of LEDVT was 0.657 (95% CI: 0.549-0.765), and the negative predictive value was 82.35%.Conclusion:PICC insertion may increase the level of D-dimer and become an important risk factor of LEDVT; For patients with PICC , D-dimer value is not suitable to rule out LEDVT.

scholarly journals Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wanli Liu ◽  
Lianxiang He ◽  
Wenjing Zeng ◽  
Liqing Yue ◽  
Jie Wei ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Venous Catheter ◽  
Upper Extremities ◽  
Central Venous ◽  
D Dimer

Abstract Background The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer. Methods This was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated. Results Univariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs. Conclusions PICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.

scholarly journals Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities

2021 ◽  
Author(s):  
Wanli Liu ◽  
Lianxiang He ◽  
Wenjing Zeng ◽  
Liqing Yue ◽  
Jie Wei ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Venous Catheter ◽  
Upper Extremities ◽  
Central Venous ◽  
D Dimer

Abstract Background: The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.Methods: This was a retrospective cohort study of 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and the D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated. Results: Univariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion tripled the risk of LEDVT and doubled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.Conclusion: PICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.

Unfractionated Heparin (UFH) For Prevention of Central Venous Catheter Thrombotic Complications in Children: A systematic review and meta-analysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Marwa W Nasef ◽  
Maha M El-gaffary ◽  
Mervet G Mansour ◽  
Esraa S Abd El Aty
Keyword(s):  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Unfractionated Heparin ◽  
Meta Analysis ◽  
Venous Catheter ◽  
Controlled Trials ◽  
Central Venous ◽  
Thrombotic Occlusion ◽  
Thrombotic Complications

Abstract Objective To determine the efficacy of unfractionated heparin in reducing central venous catheter-related deep venous thrombosis and/or catheter thrombotic occlusion in children by systematically searching the literature and conducting a meta-analysis study. Methods Four electronic databases (PubMed, Google Scholar, Elsevier’s thrombosis journal, and the Cochrane Central Register for Controlled Trials) were searched for journal peer-reviewed articles published in the period from Jan 2000 to Dec 2018. The search criteria included observational studies, and randomized controlled trials on patients aged 0–18 years with central venous catheters (CVC), which compare between the effect of UFH (flushes, lock solutions, continuous infusion, and heparin bonded catheter) and no prophylaxis (Normal saline flush or no treatment) for the prevention of CVC thrombotic complications (CVC-related deep venous thrombosis (DVT) and/or catheter thrombotic occlusion). Two authors independently reviewed and identified the eligible studies, which were assessed for study methodology including bias, and extraction of unadjusted data whenever available. To pool data from eligible studies, the meta-analysis was performed on RevMan version 5.3. Odds ratios were generated with the corresponding 95% CI through the random-effect model. Results Of the 413 articles identified, only eight studies were eligible with 1380 patients. Our results revealed that UFH was significantly superior on control group in reducing thrombotic occlusion and/or CVC-related DVT (odds ratio 0.39, 95% CI: 0.19:0.8) (p 0.01). Conclusion The published data support the hypothesis that using UFH as a thromboprophylaxis may significantly reduce catheter thrombotic complication in pediatric patients with CVC.

Characterization of central venous catheter–associated deep venous thrombosis in infants

2012 ◽  
Vol 47 (6) ◽  
pp. 1159-1166 ◽  
Author(s):  
Brian W. Gray ◽  
Raquel Gonzalez ◽  
Kavita S. Warrier ◽  
Lauren A. Stephens ◽  
Robert A. Drongowski ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Venous Catheter ◽  
Central Venous

Upper Extremity Deep Vein Thrombosis - Incidence, Risk Factors, and Management. The Worcester Venous Thromboembolism Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 584-584
Author(s):  
Frederick A. Spencer3 ◽  
Robert J. Goldberg ◽  
Darleen Lessard ◽  
Cathy Emery ◽  
Apar Bains ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Central Venous Catheter ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Venous Catheter ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background: Recent observations suggest that upper extremity deep vein thrombosis (DVT) has become more common over the last few decades. However the prevalence of this disorder within the community has not been established. The purpose of this study was to compare the occurrence rate, risk factor profile, management strategies, and hospital outcomes in patients with upper versus lower extremity DVT in a cohort of all Worcester residents diagnosed with venous thromboembolism (VTE) in 1999. Methods: The medical records of all residents from the Worcester, MA statistical metropolitan area (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible DVT and/or pulmonary embolism at all 11 Worcester hospitals during the years 1999, 2001, and 2003 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. Results: A total of 483 cases have been validated as acute DVT events - this represents all cases of DVT occurring in residents of the Worcester SMSA in 1999. For purposes of this analysis we have excluded 4 patients with both upper and lower extremity DVT. Upper extremity DVT was diagnosed in 68 (14.2%) of patients versus 411 (85.8%) cases of lower extremity DVT. Patients with upper extremity DVT were younger, more likely to be Hispanic, more likely to have renal disease and more likely to have had a recent central venous catheter, infection, surgery, ICU stay, or chemotherapy than patients with lower extremity DVT. They were less likely to have had a prior DVT or to have developed their current DVT as an outpatient. Although less likely to be treated with heparin, LMWH, or warfarin they were more likely to suffer major bleeding complications. Recurrence rates of VTE during hospitalization were very low in both groups. Conclusions: Patients with upper extremity DVT comprise a small but clinically important proportion of all patients with DVT in the community setting. Their risk profiles differs from patients with lower extremity DVT suggesting strategies for DVT prophylaxis and treatment for this group may need to be tailored. Characteristics of Patients with Upper versus Lower Extremity DVT Upper extremity (n=68) Lower extremity (n=417) P value *Recent = < 3 months Demographics Mean Age, yrs 59.3 66.5 <0.001 Male (%) 51.5 45 NS Race (%) <0.05 White 86.6 91.6 Black 1.5 3.2 Hispanic 9.0 2.0 VTE Setting (%) <0.001 Community 53.8 76.2 Hospital Acquired 46.2 23.8 Risk Factors (%) Recent Central Venous Catheter 61.8 11.9 <0.001 Recent Infection 48.5 32.4 <0.01 Recent Surgery 47.8 28.1 <0.001 Cancer 44.1 32.6 0.06 Recent Immobility 38.2 47.0 NS Recent chemotherapy 25 9.5 <0.001 Renal disease 23.5 1.7 <0.0001 Recent ICU discharge 23.5 15.1 0.07 Recent CHF 19.1 16.6 NS Previous DVT 3.0 18.7 <0.01 Anticoagulant prophylaxis (%) During hospital admission (n=125) 76.7 71.6 NS During recent prior hospital admission (n=188) 73.7 54.7 <0.05 During recent surgery (n=146) 62.5 55.3 NS Hospital therapy - treatment doses (%) Any heparin/LMWH 66.2 82 <0.01 Warfarin at discharge 53.1 71.2 <0.01 Hospital Outcomes (%) Length of stay (mean, d) 11.2 6.8 <0.01 Major bleeding 11.8 4.9 <0.05 Recurrent DVT 1.5 1.0 NS Recurrent PE 0 0.2 NS Hospital Mortality 4.5 4.1 NS

Competence of the Internal Jugular Vein Valve Is Damaged by Cannulation and Catheterization of the Internal Jugular Vein

2000 ◽  
Vol 93 (2) ◽  
pp. 319-324 ◽  
Author(s):  
Xianren Wu ◽  
Wolfgang Studer ◽  
Thomas Erb ◽  
Karl Skarvan ◽  
Manfred D. Seeberger
Keyword(s):  
Central Venous Catheter ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Color Doppler ◽  
Venous Catheter ◽  
Color Doppler Ultrasound ◽  
Surgical Patients ◽  
Venous Cannulation ◽  
Central Venous ◽  
Distal Site

Background Experimental results suggest that the competence of the internal jugular vein (IJV) valve may be damaged when the IJV is cannulated for insertion of a central venous catheter. It has further been hypothesized that the risk of causing incompetence of the proximally located valve might be reduced by using a more distal site for venous cannulation. The present study evaluated these hypotheses in surgical patients. Methods Ninety-one patients without preexisting incompetence of the IJV valve were randomly assigned to undergo distal or proximal IJV cannulation (&gt; or = 1 cm above or below the cricoid level, respectively). Color Doppler ultrasound was used to study whether new valvular incompetence was present during Valsalva maneuvers after insertion of a central venous catheter, immediately after removal of the catheter, and, in a subset of patients, several months after catheter removal, when compared with baseline findings before cannulation of the IJV. Results Incompetence of the IJV valve was frequently induced both by proximal and distal cannulation and catheterization of the IJV. Its incidence was higher after proximal than after distal cannulation (76% vs. 41%; P &lt; 0.01) and tended to be so after removal of the catheter (47% vs. 28%; P = 0.07). Valvular incompetence persisting immediately after removal of the catheter did not recover within 8-27 months in most cases. Conclusions Cannulation and catheterization of the IJV may cause persistent incompetence of the IJV valve. Choosing a more distal site for venous cannulation may slightly lower the risk of causing valvular incompetence but does not reliably avoid it.

Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis

2003 ◽  
Vol 31 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Juan A. Gutierrez ◽  
Rochelle Bagatell ◽  
Meredith P. Samson ◽  
Andreas A. Theodorou ◽  
Robert A. Berg
Keyword(s):  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Diabetic Ketoacidosis ◽  
Venous Catheter ◽  
Central Venous

Central Venous Catheter-Associated Deep Venous Thrombosis in Critically Ill Children

2017 ◽  
Vol 44 (01) ◽  
pp. 052-056 ◽  
Author(s):  
Edward Faustino
Keyword(s):  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Critically Ill ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Postthrombotic Syndrome ◽  
Central Venous ◽  
Pharmacologic Prophylaxis ◽  
Catheter Related Thrombosis

AbstractThe presence of a central venous catheter and admission to the intensive care unit are the most important risk factors for deep venous thrombosis (DVT) in children. At least 18% of critically ill children with a catheter develop radiologically confirmed catheter-associated thrombosis. Clinically apparent thrombosis occurs in 3% of critically ill children with a catheter and is associated with 8 additional days of mechanical ventilation. Even when the thrombus is initially asymptomatic, 8 to 18% of critically ill children with catheter-associated thrombosis develop postthrombotic syndrome. Thrombosis is uncommon within 24 hours after insertion of a nontunneled catheter in critically ill children, but nearly all thrombi have developed by 4 days after insertion. Hypercoagulability during or immediately after insertion of the catheter plays an essential role in the development of thrombosis. Pharmacologic prophylaxis, including local anticoagulation with heparin-bonded catheter, has not been shown to reduce the risk of catheter-related thrombosis in children. Systemic anticoagulation in critically ill children started soon after the insertion of the catheter, however, may be beneficial. A multicenter clinical trial that is testing this hypothesis is currently underway.

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