Experience in consultation and treatment of cancer patients with catheter-related thrombosis
Author:
Affiliation:

1.Department of Vascular Surgery, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China;2.Department of Medical Examination of Health Care Center, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China;3.Department of Radiotherapy, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China

Clc Number:

R654.3

Fund Project:

  • Article
  • |
  • Figures
  • |
  • Metrics
  • |
  • Reference
  • |
  • Related
  • |
  • Cited by
  • |
  • Materials
  • |
  • Comments
    Abstract:

    Background and Aims The peripherally inserted central catheter (PICC) provides a safe therapeutic venous access for cancer patients requiring long-term infusions of chemotherapeutic agents. However, with the widespread use of PICC in clinical practice, the PICC-related complications such as thrombosis, infections, phlebitis, and catheter disconnection or displacement have substantially increased, especially the catheters related thrombosis (CRT) in PICC, which seriously interferes the patient management activities of the cancer care departments, and also affects the prognosis of patients. Therefore, this study was performed to investigate the treatment strategies for CRT in cancer patients through a retrospective analysis of the consultation opinions for these patients and their treatment results.Methods The clinical data of 92 cancer patients with CRT who were consulted by the physicians in the Department of Vascular Surgery of Hainan Provincial People's Hospital from April 23, 2014 to January 10, 2020 were retrospectively analyzed. All patients were definitively diagnosed by color ultrasound examination. Of the patients, 74 cases (80.4%) were asymptomatic, 9 cases (9.8%) had infection symptoms, and 9 cases (9.8%) had symptoms of thrombosis. The consultation questions mainly included that the timing of extubation or feasibility of maintaining intubation, requirement of antithrombotic therapy, and necessity of immobilization.Results Direct extubation was recommended in 48 patients (52.2%, 43 cases without symptoms, 3 cases with infection symptoms and 2 cases with symptoms of thrombosis); continuous intubation was advised in 30 cases (32.6%, 23 cases without symptoms, 3 cases with infection symptoms and 4 cases with symptoms of thrombosis); delayed extubation and discontinuation of PICC were suggested in 14 patients (15.2%, 8 cases without symptoms, 3 cases with infection symptoms and 3 cases with symptoms of thrombosis); antithrombotic therapy with anticoagulation and (or) antiplatelet medications were considered in 32 case (34.8%, 20 cases without symptoms, 4 cases with infection symptoms and 8 cases with symptoms of thrombosis), and the other 60 cases (62.5%) were not prescribed antithrombotic therapy; 4 cases were found requiring immobilization of the affected limb (4.3%, 1 case with infection symptoms and 3 cases with symptoms of thrombosis), and the remaining 88 cases (95.7%) were not requested for immobilization or immobilization for them was not mentioned during the specialist consultation. All the 92 patients underwent treatment following the consultation opinions, and no symptomatic or fatal pulmonary embolism, and events of newly developed thrombosis or thrombosis aggravation occurred. Analysis among the 74 asymptomatic patients showed that whether performing antithrombotic therapy or immobilization exerted no significant influences on the occurrence of pulmonary embolism in this type of patients (both χ2=0, P>0.05).Conclusion For asymptomatic CRT patients, direct extubation or continuous intubation can be considered, proper movement of the affected limb is recommended, and antithrombotic therapy yield no obvious clinical benefit. For those combined with infection, treatment should be individualized, appropriate anticoagulation and immobilization are feasible for the severe cases, while anticoagulation is not recommended but proper movement of the affected limb is helpful for the mild cases. For symptomatic CRT patients, the standard antithrombotic treatment and immobilization according to the management protocol and relevant guidelines for the upper extremity deep venous thrombosis are recommended.

    Reference
    Related
    Cited by
Get Citation

LI Zhenzhen, LIU Min, ZHANG Shuai, ZENG Zhaofan, CHEN Hao, XIAO Zhanxiang, QI Youfei. Experience in consultation and treatment of cancer patients with catheter-related thrombosis[J]. Chin J Gen Surg,2022,31(6):806-812.
DOI:10.7659/j. issn.1005-6947.2022.06.014

Copy
Share
Article Metrics
  • Abstract:
  • PDF:
  • HTML:
  • Cited by:
History
  • Received:December 30,2021
  • Revised:May 09,2022
  • Adopted:
  • Online: July 11,2022
  • Published: