The Effect of Laterality on Venous Thromboembolism Formation after Peripherally Inserted Central Catheter Placement
The Effect of Laterality on Venous Thromboembolism Formation after Peripherally Inserted Central Catheter Placement
复制标题
侧向对外周插入中心静脉导管放置后静脉血栓栓塞形成的影响
作者：
B. Sperry;M. Roskos;R. Oskoui
目的外周中心静脉导管（PICCs）在医院医学中的应用越来越广泛。PICCs优先放置在右侧，因为解剖上易于插入上腔静脉。然而，没有数据表明这种做法是否也能预防症状性静脉血栓形成。本研究的目的是评估在社区教学医院放置右侧与左侧PICCs和由此产生的静脉血栓栓塞（VTE）率。方法与结果对2008年在我院社区教学医院连续就诊的798例PICCs进行回顾性分析。检查PICC放置的适应症、PICC放置的侧边、导致超声评估的体征和症状以及由此产生的静脉血栓栓塞位置。672名患者在一年中总共放置了798个picc，其中568个是右侧导管，230个是左侧导管。其中49例患者在PICC放置后30天内需要68次多普勒超声检查。其中47例（8.27%）为右侧PICCs， 21例（9.13%）为左侧PICCs （OR 0.90, 95% CI 0.52-1.54）。1.23%的右侧picc和1.30%的左侧picc发生静脉血栓栓塞事件（OR 0.94, 95% CI 0.24-3.68）。该并发症的总发生率为1.25%。发现血栓的平均时间为13.6天。结论PICC放置的侧边与症状性静脉血栓形成无显著相关性。在我们的研究中，血栓形成的总体比率与以往的研究相当。
Purpose The use of peripherally inserted central venous catheters (PICCs) has become widespread in hospital medicine. PICCs are preferentially placed on the right side due to anatomic ease of insertion into the superior vena cava. However, no data exists examining whether this practice is also protective against symptomatic venous thrombosis. The purpose of this study is to assess placement of right-sided versus left-sided PICCs and the resulting rates of venous thromboembolism (VTE) in a community teaching hospital. Methods and Results A retrospective analysis was performed of 798 sequential PICCs placed in our community teaching hospital in 2008. Indication for PICC placement, laterality of PICC placement, and signs and symptoms leading to ultrasound assessment were examined as well as the resulting VTE location. Six hundred and seventy two patients had a total of 798 PICCs placed over the course of the year, 568 of these were right-sided catheters, and 230 were left-sided catheters. Forty-nine of these patients required 68 Doppler ultrasounds within 30 days of PICC placement. Of these ultrasounds, 47 (8.27%) followed right-sided PICCs and 21 (9.13%) followed left-sided PICCs (OR 0.90, 95% CI 0.52–1.54). VTE events were documented in 1.23% of right-sided PICCs and 1.30% of left-sided PICCs (OR 0.94, 95% CI 0.24–3.68). The overall incidence of this complication was 1.25%. Mean time until discovery of the thrombus was 13.6 days. Conclusions Laterality of PICC placement is not significantly associated with symptomatic VTE formation. The overall rate of thrombosis in our study is comparable to that of previous studies.