Peripherally inserted central catheter (PICC)-related thrombosis (CRT) is a critical complication in cancer patients. However, the impact of vascular morphological parameters on the risk of this complication remains poorly understood. This study aimed to identify independent risk factors associated with vascular morphology and develop a nomogram for predicting CRT. Cancer patients who underwent placement of a PICC at a tertiary hospital between 2021 and 2023 were retrospectively identified. Vascular parameters (vessel depth, vessel diameter, arm circumference) and procedural factors (cannulation/attempts, catheter tip position) were assessed by ultrasonography. Independent risk factors for CRT were identified by multivariate logistic regression and Cox proportional hazards models. A nomogram was constructed using the rms package in R. Discrimination was evaluated via the area under the curve and calibration by the Hosmer–Lemeshow goodness-of-fit test. A PICC was placed in 2,183 cancer patients during the study period. CRT occurred in 102 (4.7

Purpose:Ultrasound evaluation of target vein diameter before peripherally inserted central catheter (PICC) placement is recommended to control the catheter-to-vein ratio, but early hemodynamic changes after PICC placement remain incompletely characterized. This study evaluated the associations of patient morphology and baseline venous anatomy with early changes in upper-extremity venous blood flow velocity after PICC insertion. Patients and Methods:In this prospective single-center cohort study, 519 adult patients with cancer requiring PICC insertion were enrolled. Body mass index (BMI), arm circumference, baseline vascular depth, and baseline vascular diameter were recorded before catheterization. Time-averaged mean venous blood flow velocity was measured by Doppler ultrasound before insertion and on day 1 after insertion under identical conditions. Multivariable linear regression was used to identify factors independently associated with day-1 flow velocity and with the change in flow velocity. Results:All 519 patients completed baseline and day-1 assessments. Mean blood flow velocity decreased from 14.87 ± 4.42 cm/s at baseline to 14.28 ± 4.87 cm/s on day 1 (mean difference, -0.59 cm/s; 95% CI, -1.08 to -0.10; p = 0.017); the effect size was small (Cohen's dz = -0.10) and the clinical significance of this change is uncertain. The mean catheter-to-vein ratio was 30.8% ± 6.6%, and 36.4% of patients exceeded a ratio of 33%. In multivariable analyses, baseline vascular diameter was independently associated with both day-1 flow velocity (adjusted β, 7.25 cm/s per cm; 95% CI, 2.85-11.64; p = 0.001) and the change in flow velocity (adjusted β, 8.33 cm/s per cm; 95% CI, 3.18-13.48; p = 0.002), with smaller veins showing lower post-insertion velocities and greater reductions. Body mass index was independently associated with day-1 flow velocity (adjusted β, 0.24 cm/s per kg/m2; 95% CI, 0.10-0.38; p = 0.001). Conclusion:Patient morphology and venous anatomy were associated with different patterns of early hemodynamic change after PICC insertion. This study evaluated hemodynamic changes only; catheter-related thrombosis was not assessed, and no conclusions regarding thrombosis risk can be drawn. The observed velocity reduction was small and of uncertain clinical significance. These findings are hypothesis-generating, and future studies incorporating thrombosis endpoints are needed.

Routine post-insertion chest radiography (CXR) to confirm central venous catheter position is limited by its retrospective nature, radiation exposure, and procedural delays. This study evaluated the feasibility, safety, and efficiency of a standardized multimodal intra-procedural ultrasound protocol as an alternative to routine radiography in patients requiring subclavian centrally inserted central catheter (CICC) placement. This single-centre, prospective, observational agreement study included 868 adult patients undergoing placement of a CICC in a subclavian vein. A standardized intra-procedural ultrasound protocol integrating vascular tip navigation, the rapid atrial swirl sign (RASS) for tip location, and lung sliding assessment was performed. Routine post-insertion CXR served as the institutional reference comparator. The primary outcome was agreement between ultrasound and CXR on the final post-correction catheter status. Secondary outcomes included the final residual malposition rate, pneumothorax detection, turnaround time, cost-effectiveness, and environmental impact. Intra-procedural ultrasound identified initial catheter malposition in 51 cases (5.9

ObjectiveThis study aims to assess the efficacy and safety of the integrated puncture method compared to the conventional puncture method in cancer patients undergoing PICC placement.MethodsThe retrospective analysis included 224 cancer patients who underwent PICC placement at the vascular access center of Beijing cancer hospital from March 2023 to September 2023, with 111 patients in the integrated puncture method group and 114 patients in the conventional puncture method group.ResultsThe integrated puncture method group demonstrated a significantly higher one-needle puncture success compared to the conventional puncture method group (P = .01). Additionally, the group exhibited notably lower rates of blood-borne exposure and post-operative subcutaneous congestion (P < .001, P = .04). The integrated puncture method group also led to significantly shorter durations for tourniquet application, puncture time, and overall catheterization time compared to the conventional puncture method group (All P < .001). No statistically significant differences were observed between the two groups regarding post-operative complications such as dermatitis, catheter-related infection, catheter blockage, and catheter-related thrombosis (P > 0.05).ConclusionThe integrated puncture method for PICC placement enhances one-time puncture success rates, improves catheterization efficiency, and reduces the risks of blood-borne exposure and subcutaneous congestion.

BACKGROUND:Peripherally inserted central catheters (PICCs) are widely used in cancer patients but carry a significant thrombosis risk. While body mass index (BMI) is recognized as a thrombogenic factor, the role of vascular morphology remains unclear. MATERIALS AND METHODS:A total of 338 adults with cancer requiring PICC insertion at our hospital were prospectively enrolled between January 11 and 30 December 2023. All study participants underwent ultrasound-guided PICC placement using a 4-Fr single-lumen catheter. Patients were monitored for thrombosis by serial ultrasonography. Demographic, clinical, and vascular characteristics were compared between patients who developed thrombosis and those who did not. RESULTS:PICC-related thrombosis developed in 35.5% of patients and was asymptomatic in 75.8% of cases. Bivariate analysis showed that BMI, vessel depth, arm circumference, vessel diameter, and blood flow velocity on the first post-insertion day were associated with the risk of thrombosis (P<0.05). Multivariate regression analysis identified shallower vessel depth (<1.0 cm, odds ratio [OR] 0.324, 95% confidence interval [CI] 0.120-0.874, P = 0.026) and smaller post-insertion vessel diameter (reduction <0.6 cm, OR 0.025, 95% CI 0.001-0.550, P = 0.019) as independent risk factors for thrombosis. Blood flow on the first post-insertion day was significantly slower in the thrombosis group (13.4 cm/s vs. 14.9 cm/s, P = 0.007). Blood flow velocity increased with increasing BMI, peaking at a BMI of 28.3 kg/m 2 before declining beyond this threshold. CONCLUSION:Low BMI and poor vascular morphology increase the risk of PICC-related thrombosis. The influence of BMI is likely mediated by vascular remodeling, with blood flow velocity peaking at 28.3 kg/m 2 before declining, reflecting a compensatory hemodynamic balance.

BackgroundCentral venous catheters (CVCs) are widely used in critically ill patients, including cancer patients, but are associated with complications such as catheter-related bloodstream infections (CRBSIs). This study evaluates the effectiveness of polyhexamethylene biguanide (PHMB)-coated CVCs in reducing catheter-tip bacterial colonization in cancer patients undergoing abdominal surgery.MethodsA prospective, randomized, monocentric clinical trial was conducted at Peking University Cancer Hospital from March 2017 to April 2019. Surgical cancer patients requiring CVCs were randomized into two groups: a PHMB-coated CVC group (Certofix® protect) and a standard CVC group (Certofix®). The primary outcome was catheter tip bacterial colonization, and the secondary outcomes included catheter retention time and hospital length of stay.ResultsA total of 1,185 patients were included in the analysis. The incidence of catheter tip bacterial colonization was 2.5% in the PHMB-coated group and 4.2% in the standard CVC group (p = 0.10). Hospital length of stay was significantly shorter in the PHMB-coated group (p < 0.001). Subgroup analysis showed reduced bacterial colonization in male patients in the PHMB-coated group (p = 0.04).ConclusionPolyhexamethylene biguanide-coated CVCs did not significantly reduce catheter tip bacterial colonization in the overall population but showed a beneficial effect in male cancer patients undergoing abdominal surgery. In clinical practice, it is necessary to consider various factors when selecting the type of catheter.Clinical trial registrationNo. chiCTR-IPR-16010027.

Abstract Background The optimal duration and choice of anticoagulant for the treatment of Peripherally inserted central catheters (PICC)-related upper extremity deep vein thrombosis (UEDVT) in cancer patients are still undetermined. Objectives The aim of this study was to assess the efficacy and safety of rivaroxaban for the treatment of PICC-related UEDVT in cancer patients. Methods We conducted a retrospective cohort study including consecutive cancer patients for the management of acute symptomatic PICC-related UEDVT. The efficacy outcome of the study was the 180-day recurrence of any venous thromboembolism (VTE), while the safety outcome was the 180-day incidence of all bleeding events. The Kaplan‒Meier method was used to estimate the overall incidence. Hazard ratios (HRs) were obtained with a Cox proportional hazards model to estimate the risk of the outcome events. Results A total of 217 patients were included in the final analysis with a median age of 56 years old, 41.5% of whom had metastases. After the initial 3–5 days of nadroparin, patients received sequential anticoagulation, either with nadroparin (118 patients) or with rivaroxaban (99 patients). Four patients with recurrent VTE were observed (nadroparin, n = 2; rivaroxaban, n = 2). The 180-day cumulative VTE recurrence rates were 1.7% and 2.0% (p = 0.777) in patients receiving nadroparin and rivaroxaban, respectively. The overall bleeding rate at 180 days was 8.8%. Although no major bleeding events were observed, nineteen patients with clinically relevant nonmajor bleeding (CRNMB) were observed. The 180-day cumulative rate of CRNMB was 5.1% for nadroparin and 13.1% for rivaroxaban (HR = 3.303, 95% CI 1.149–9.497, p = 0.027). Conclusion Our study supported the efficacy of rivaroxaban for treating PICC-related UEDVT in cancer patients. However, data on anticoagulation therapy for PICC-related UEDVT presented with a low risk of VTE recurrence and a relatively high risk of CRNMB bleeding events. Considering the risk–benefit ratio, further well-designed trials are required to optimize the drug selection and duration for the treatment of PICC-related UEDVT in cancer patients.

本文对4例末端瓣膜式耐高压注射型经外周静脉置入中心静脉导管（PowerPICC SOLO）导管体内破损病例进行总结，从导管材质、置管静脉选择等视角剖析导管体内破损的相关因素并采取相应预防措施，以期为临床研究及实践提供参考。

Background: The placement of peripherally inserted central venous catheters (PICCs) has traditionally relied on measurements and anatomical landmarks. It involves post-placement chest X-rays (CXRs) and occasional repositioning, which incur additional direct and indirect costs, such as delays in care and staff time. The aim of this study was to assess the cost-effectiveness of a routine post-procedural CXR in the era of ultrasound and intracavitary electrocardiography (IC-ECG)-guided PICC insertion. Methods: A retrospective two-center study was conducted to review the clinical records of all patients who had PICCs in the Venous Access Center of Peking University Cancer Hospital & Institute and The Affiliated Qingdao Central Hospital of Qingdao University between 1 January 2019 and 30 June 2020. PICC placement was only available to patients who were 18 years or older, had in-sinus rhythm. The incidence of catheter misplacement after insertion was measured. Cavoatrial junction or the lower third of the superior vena cava (SVC) were defined as ideal catheter tip locations. A logistic regression analysis was performed to examine potential risk factors associated with PICC-related complications and a cost analysis was conducted to assess the economic impact of the use of CXR. Results: There were 2,863 samples from 2,653 patients included. The overall incidence of intraprocedural and primary catheter misplacement was 7.3% (n=210) and 0.70% (n=20), respectively. There was a high risk of primary catheter misplacement when the left-arm was chosen for placement [odds ratio (OR): 11.163; 95% confidence interval (CI): 3.720-33.495; P<0.001]. The overall cost of performing CXR for screening of PICC-related complications was $23,858 per year, and that of using CXR to diagnose 1 case of catheter misplacement was $1,789. Conclusions: This study confirms that misplacement of PICCs guided by ultrasound and IC-ECG is rare and that postprocedural CXR is very costly. In our setting, routine postprocedural CXR is unnecessary especially when the PICC is catheterized in the right arm, and is not a wise option.

目的 探讨肿瘤患者耐高压瓣膜型PICC导管置管后最佳体外留置导管长度,为临床预防非计划拔管护理实践提供依据.方法 选择2019年1月至2020年1月在超声引导下结合赛丁格技术行耐高压瓣膜型PICC置管肿瘤患者992例,随机分为观察组494例和对照组498例,对照组置管后导管外露2 cm采用U型固定法,观察组置管后导管外露0 cm采用一字型固定法,比较两组患者导管脱出、非计划拔管发生率.结果 观察组导管脱出和非计划拔管发生率明显低于对照组(P<0.05).结论 耐高压瓣膜型PICC导管置管后外露0 cm一字型固定法可显著降低导管脱出率及患者的非计划拔管率.

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.

PURPOSE:A peripherally inserted central catheter (PICC) is associated with venous thromboembolism (VTE) especially in patients suffering from cancer. We analyzed the incidence, risk factors, and patterns of PICC-related VTE in cancer patients.PATIENTS AND METHODS:Patients with cancer who underwent PICC placement were evaluated retrospectively. Routine, prospective ultrasound post-PICC placement was used for asymptomatic and symptomatic patients to identify VTE. Multivariable logistic regression models with odds ratios (ORs) were used to examine VTE risk factors.RESULTS:Of 2353 PICCs placed, 165 patients (7.01%) developed PICC-related VTE with a median thrombosis time of 12 days. After adjustment of multivariable analysis, patients with PICC-related VTE were more likely to have a ratio of PICC diameter:vein diameter >0.35 (adjusted OR, 1.689; 95% CI, 1.023-2.789) and high level of triglycerides (1.561; 1.096-2.223). The prevalence of A (adjusted OR, 1.680; 95% CI, 1.009-2.798), B (1.835; 1.137-2.961), and AB (3.275; 1.840-5.829) blood group was significantly higher than that of the O blood group in VTE patients. Venous recanalization was observed in 44.8% (74/165) patients after anticoagulation therapy, and more often in patients with combined deep VTE than in patients with isolated superficial VTE (OR, 17.942; 95% CI, 5.427-59.316). The recanalization time was 20±5 (range, 10-31) days.CONCLUSION:The non-O blood group, larger ratio of PICC diameter:vein diameter, and high level of triglycerides were significantly associated with PICC-related VTE. Almost half of cases of PICC-related deep VTE could be reversed by anticoagulation treatment.

BACKGROUND:This study aimed to compare the tip location of peripherally inserted central catheter (PICC) under two forward P-wave amplitudes (P-wave amplitude is the autonomous peak or P-wave amplitude is 50-80% of the QRS main wave) by intracavitary electrocardiogram (IC-EKG) to determine the PICC tip in optimal location thus avoiding catheter-related complications. METHODS:The data of 300 cancer patients with PICC insertion were collected retrospectively. For the observation group, the position of the catheter tip was left at the level when P wave amplitude was its autonomous peak (168 patients catheterized in 2018). While for the control group, the catheter tip was left at the level when the P wave amplitude was 50-80% of the QRS main wave (132 patients catheterized in 2017). Both groups of patients underwent the chest X-ray examination (CXR) after catheterization. The total compliance rate [PICC tip was located in the lower third of the Superior Vena Cava (SVC) and the Cavo-Atrial Junction (CAJ)], the optimal position compliance rate (PICC tip was located in the CAJ), and the incidence of the catheter tip malposition were compared between the two groups. The complications after catheterization including arrhythmia after catheterization within 24 hours, catheter-related thrombosis, catheter dysfunction, and catheter infection within 90 days were also compared. RESULTS:There was no difference in the total compliance rate of PICC tip position and the incidence of the catheter malposition in the two groups (P>0.05). But the optimal position compliance rate of the observation group was higher than that of the control group (P<0.05). There was no difference in the incidence of arrhythmia after catheterization within 24 hours of the two groups (P>0.05). The incidence of catheter-related thrombosis, catheter dysfunction, and catheter infection within 90 days in the observation group was lower than those in the control group (P<0.05). CONCLUSIONS:The PICC tip position at the autonomous peak of the P wave is significantly better than that at the P wave amplitude being 50-80% of the QRS main wave under the IC-EKG guidance for PICC insertion.

目的:结合行锁骨下静脉穿刺经验,探讨减少穿刺术中并发症的措施.方法:回顾性分析2018年1月1日至2020年1月1日在北京大学肿瘤医院静脉通路中心进行中心静脉置管的1 480例病人.结果:所有病人中196例首先尝试行左侧锁骨下静脉穿刺,1 284例首先尝试行右侧锁骨下静脉穿刺,其中左侧锁骨下静脉穿刺3针及以内成功172例(87.8％),右侧为1 108例(86.3％),两组差异无统计学意义(P＞0.05).3针以内未成功者改行颈内静脉或B超引导下锁骨下-腋静脉穿刺,总体成功率100％.本组共2例(1.4‰)出现气胸.本组病人穿刺过程中置入导丝时导丝上拐至颈内静脉,左侧出现5例(2.6％),右侧出现80例(6.2％),两组差异具有统计学意义(P＜0.05).术中经过B超辅助调整导丝位置再置管,术后复查胸片无导管异位发生.结论:在锁骨下静脉穿刺中避免同一部位反复穿刺,可以减少气胸发生.在锁骨下静脉穿刺术中通过助手辅助行B超检查判断置入导丝是否拐入颈内静脉,若拐入颈内静脉及时重新调整导丝可以减少术后导管异位.

Background : In China, routine chest X-ray (CXR) is generally required for peripherally inserted central venous catheters (PICC) to determine the position of the catheter tip. The aim of this study is to assess the value of a routine post-procedural CXR in the era of ultrasound and intracavitary electrocardiography(IC-ECG) -guided PICC insertion. Methods : A retrospective population-based cohort study was conducted to review the clinical records of all patients who had PICCs in the Venous Access Center of Beijing Cancer Hospital between January 1, 2019 and June 30, 2020. The incidence of catheter misplacement after insertion was measured. A logistic regression analysis was performed to examine potential risk factors associated with PICC-related complications and a cost analysis to assess the economic impact of the use of CXR. Results : There were 2,857 samples from 2,647 patients included. The overall incidence of intraoperative and postoperative catheter misplacement was 7.4% (n=210) and 0.67% (n=19), respectively. There was a high risk of postoperative catheter misplacement when the left-arm was chosen for placement (OR: 10.478; 95% CI: 3.467-31.670; p<0.001). The cost of performing CXR for screening of PICC-related complications was $23,808 per year, and that of using CXR to diagnose one case of catheter misplacement was $1253. Conclusion : This study confirms that misplacement of PICCs guided by ultrasound and IC-ECG is rare and that postoperative CXR is very costly. In our setting, routine postoperative CXR is unnecessary and not a wise option.

Objective: To evaluate the potential relation between the ABO blood group and the risk of venous thrombosis in cancer patients with peripherally inserted central catheters (PICCs). Methods: The patients who underwent PICC catheterization in Beijing Cancer Hospital from January 2018 to October 2019 were retrospectively analyzed. The general information, disease diagnosis, catheterization situation, and complications were recorded for each patient. Further, the blood group status was identified using the hospital information systems. Logistic and Cox proportional hazard regression analyses were performed to identify the risk factors for symptomatic PICC-related thrombosis. Results: Among the 2315 patients, 131 had symptomatic thrombosis after PICC catheterization. The incidence of symptomatic thrombosis was lower in patients with blood type O when compared with that in patients with blood types other than O. The history of venous thrombosis, tumor category, arm circumference, and insertion attempts are risk factors associated with the PICC-related venous thromboembolism (VTE). After multivariable adjustment, insertion attempts and the non-O blood type were observed to remain associated with thrombosis. Conclusion: The risk of PICC-related thrombosis in patients with non-O blood type is significantly higher than that in patients with blood type O.

Background With increasing use, peripherally inserted central catheters (PICCs) are associated with the risk of venous thrombosis. Few studies have focused on the relationships between venous thrombosis and venous characteristics. This study aimed to identify effects of venous characteristics on symptomatic PICC-related venous thrombosis in cancer patients and explore the relationship between venous characteristics and blood flow velocity. Methods The data of patients who underwent placement of PICC were retrospectively studied between January 2015 and September 2017. Symptomatic PICC-related venous thrombosis was confirmed by ultrasound. Univariable, multivariable logistic regression analyses were performed to identify the risk factors associated with PICC-related venous thrombosis. In October 2017, 169 patients with PICCs were enrolled prospectively, and the relationships between blood flow velocity and venous characteristics were recorded and analyzed. Results A total of 2933 cancer patients were enrolled in this study; of these patients, 68 experienced symptomatic venous thrombosis. In the bivariate analysis, body mass index (BMI), history of venous thrombosis, triglycerides, tumor category, vessel diameter, vessel depth and arm circumference were associated with thrombosis. The multivariable analyses showed that arm circumference, vascular diameter, triglyceride level and tumor category were independent risk factors for thrombosis. Blood flow velocity was positively correlated with vessel depth and arm circumference but not with vessel diameter. Conclusion Different venous characteristics can lead to different blood flow rates, which can affect the incidence of thrombosis. A vein depth of greater than 1.07cm or less than 0.57cm was associated with a higher incidence of PICC-related venous thrombosis, and the greater the arm circumference and vessel diameter, the greater the risk of venous thrombosis.

目的 集束化管理对肿瘤患者经外周置入的中心静脉导管(peripherally inserted central catheter,PICC)留置期间医用粘胶相关性皮肤损伤(medical adhesive related skin injury,MARSI)中的应用效果,为减少肿瘤患者留置PICC期间医用粘胶相关性皮肤损伤的发生提供参考.方法 将2016年4月至8月678例留置PICC的门诊肿瘤患者作为对照组,并对发生MARSI的病例进行回顾,从护理人员及患者两方面分析患者出现MARSI的原因,制订护理干预措施.2016年9月开始护理人员采取加强对MARSI知识的学习,对患者皮肤的评估、改进导管维护方法、选择合适的敷料种类等护理干预措施.将2017年4至8月采用护理干预措施的1109例患者作为观察组,比较两组发生MARSI的情况.结果 实施护理干预措施后,留置PICC的肿瘤患者MARSI的发生率由2016年的12.39％下降至2017年的2.61％,差异有显著性(x2=67.86,P<0.001).结论 实施预防控制等护理措施对降低MARSI在肿瘤患者PICC留置期间的发生具有一定临床应用价值.