Upper Extremity Deep Vein Thrombosis Clinical Trial
Official title:
PICC and Midline Related Complications: A Multicenter Observational Study
Most important peripherally inserted central catheter (PICC) and Midline complications are thrombosis and catheter related blood stream infections. No large prospective observational study are present in literature about these topics. The aim of this multicenter prospective observational study is to analyze all the complications due to PICC and Midline insertion.
A PICC line is a Peripherally Inserted Central Catheter. It is long, small, flexible tube
that is inserted into a peripheral vein, typically in the upper arm, and terminates in a
large vein in the chest to obtain a central intravenous access. A Midline catheter is similar
to a PICC, but it is shorter in length (about 25 cm) and is inserted into a large vein in the
upper arm, terminating not beyond the axillary vein. Midline catheters offer a longer dwell
time and better hemodilution than the short peripheral IV catheters.The use of PICC and
Midline has been increasing in outpatient and inpatient settings. Factors driving this
increased use include their ease of insertion due to the placement into a peripheral vein—a
safer approach—with the benefit of a central tip location appropriate for any osmolarity and
pH infusions, a low reported incidence of infection, a better patient comfort, a durable
venous access, and an easier nursing management in outpatient setting. PICC placement under
ultrasound guidance can be carried out with no iatrogenic, mechanical complications
associated with central venous catheter insertion in the neck or chest (pneumothorax,
hemothorax etc…). Despite their many advantages, recent data suggest that PICCs are
associated with venous thromboembolism. The incidence of symptomatic thrombosis ranges from
1.9% to 8.4% and it increases to 75% considering also the asymptomatic one. The risk factors
that predispose a patient to the development of a thrombotic complication are: the caliber of
the device (≥5Fr), the position of the catheter tip, the insertion of the PICC in a paretic
limb, a history of venous thrombosis, the residence time of the device and the presence of an
oncological pathology. The second major complication due to the PICC insertion is the
catheter related blood stream infection (CRBSI). The incidence of PICC-BSI in literature
ranges from 2.0 per 1000 catheter days to 3.1 per 1000 catheter days. This disparity stems
from the fact that there is no single definition of catheter infection. Multiple factors
associated with patient and catheter care have been identified has having an increased risk
of CRBSI and are amenable to preventive measures. Independent risk factors for PICC BSIs
included congestive heart failure, intrabdominal perforation, Clostridium difficile
infection, recent chemotherapy, presence of tracheostomy, and type of catheter (double or tri
lumen). Limited data exists regard prospective observational study on deep vein thrombosis
and CRBSI related to PICC and Midline insertion, including the different calibers of the
device and the presence of single or multiple lumen.
The investigators designed a multicenter prospective observational study to determine the
incidence of deep vein thrombosis, related/associated catheter blood stream infections and
the incidence of all the minor complications due to PICC and Midline insertion.
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