Does PICC side matter? The experience at our hospital

Introduction: The use of a peripherally inserted central catheter (PICC) provides an improvement in long-term intravenous therapy in terms of patient safety, quickness and ease of placement, and reduced rates of complications. These advantages make them the first choice over other catheters such as port-a-cath or Hickman, which in years ago were traditionally used. One possible complication is upper-extremity deep vein thrombosis (DVT) at the point of PICC insertion. Insertion on the left side has been considered a risk factor of DVT. PICC is inserted through a vein in the arm and requires care that can limit day-to-day functioning, especially in patients with long-term exposure. For this reason, in our center most of PICC lines are inserted on the left side (to avoid insertion on the dominant side). The aim of this study was to analyse the incidence of PICC-related DVT and the risk factors of DVT in patients with gastrointestinal tumours in our centre. Methods: This study was conducted in a retrospective observational study design and collected data of chemotherapy-treated ambulant patients with gastrointestinal cancer who underwent PICC insertion between January 2013 and December 2016 in the medical oncology unit of Valme University Hospital in Seville, Spain. PICCs were inserted by expert trained physicians, by ultrasound-guided technique. The main endpoint was catheter-related thrombosis confirmed on Doppler ultrasound in all symptomatic patients. Electronic patient records were reviewed for age, gender, and risk factors for PICC-related DVT, such as metastatic cancer, catheter diameter, insertion at the left upper arm, infection at the point of insertion, and administration of anti-angiogenic drugs or erythropoietin. Data analysis was performed using SPSS software, version 21 (IBM Corp., Armonk, NY, USA). Descriptive statistics for continuous variables included mean, median and range. The number and proportions of the categorical data were used to characterize the demographics and baseline characteristics of the study population. Chi-squared test, or Fischer exact test when necessary, were conducted to examine the association between the risk factors and the development of catheter-related thrombotic events. Results: Data from 174 inserted PICCs were collected. Median patient age was 62 years old (range 29 to 85). Of these, 60.3% and 39.7% were male and female, respectively. The most frequent diagnosis was colorectal cancer (74.7%). In total, 71.8% of patients were in a metastatic stage at the time of PICC insertion. Mean catheter duration was 296 days. In 87.9% of cases, the catheter was inserted in the left arm. An infection at the insertion point occurred in 7.5% of patients. PICC-related DVT rate was 6.9% (12 patients). From all analysed risk factors, we found a significant relationship between thrombosis and infection at the point of catheter insertion (P < .05). Conclusion: The use of long-term PICC in our patients with gastrointestinal cancer was safe, with a low incidence of PICC-related DVT compared with the literature. For these patients, PICC insertion on the left side was not a risk factor for DVT. Having suffered an infection at the catheter insertion point was a risk factor for developing a PICC-related DVT.