Risk of Venous Thromboembolism in Hospitalized Medical Cancer Patients with Midline and Peripherally Inserted Central Catheters
Kaatz S, Ratz D, McLaughlin E, Flandars S, Czilok T, and Chopra V. Risk of Venous Thromboembolism in Hospitalized Medical Cancer Patients with Midline and Peripherally Inserted Central Catheters. Res Pract Thromb Haemost 2019; 3:706.
Res Pract Thromb Haemost
Background : Peripherally inserted central catheters (PICC) and cancer are well established risks for venous thromboembolism (VTE) in hospitalized medical patients. Midlines, shorter devices where the catheter tip resides just short of the subclavian vein, may have less risk of VTE and offer an alternative in hospitalized cancer patients that are not receiving chemotherapy. Aims : Compare up to 30 days after PICC/Midline placement rates of VTE between midline catheters and PICCs in non-surgical cancer patients that did not receive chemotherapy through these lines. Methods : Trained abstractors collected clinical data on a representative sample of PICC/Midline placements at 47 hospitals participating in the Michigan Hospital Medicine Safety (HMS) consortium. Patients were followed until the minimum time of PICC/Midline removal, death or 30 days. Patient charts were abstracted for demographics, device characteristics, catheter use, medical conditions and medications. Cancer was defined as having active treatment within 6 months of hospital admission. Rates of total VTE, upper extremity deep vein thrombosis (DVT) and lower extremity DVT were compared with chi-square or Fisher's exact test. Results : Mean age of patients was 66.6 (sd 13.4) years, 52.9% male, and 75.0% white, 18.6% black race. The 30-day rate of any VTE occurred in 3.93% with PICC lines and 1.88% with midlines, p = 0.19 (table). There were many more PICCs than midlines in our cohort and only 3 VTE in patients with midlines. Conclusions : Our study suggest a doubling of risk of VTE with PICCs and may be underpowered to show a difference. Larger studies or randomized trials are needed to elucidate if substitution of midlines for PICC lines offers an opportunity to decrease VTE in hospitalized non-surgical cancer patients.