Background

Multi-lumen and hence larger diameter peripherally inserted central catheters (PICCs) are often necessary in patients undergoing cancer treatment to infuse multiple or incompatible infusions. However, anecdotal reports suggest that some clinicians request larger multi-lumen devices when they are not clinically indicated and it is thought that larger diameter PICCs may increase the risk of upper-extremity thrombus.

 Aim

Determine the influence of PICC diameter on the risk of upper-extremity thrombus in a cancer patient cohort.

Methods

Adult cancer patients referred for PICC insertion at a metropolitan teaching hospital were recruited May 2013-January 2014. Radiology reports were used to identify cases of symptomatic thrombus.

Results

There were 66 participants recruited, 58% female, mean age 57 (SD 14.97). Equal numbers of participants had haematological cancers and solid tumours. 55% had a single lumen PICC, 36% had a double lumen PICC and 9% had a triple lumen PICC. 14% of participants had stem cell transplant (n=9); 26% blood products (n=17); 92% chemotherapy (n= 61); 29% intravenous antibiotics (n=19) and 3% (n=2) total parenteral nutrition (many participants had more than one infusion through the PICC). 5% (n=3) developed symptomatic thrombus post PICC insertion (one participant with a double lumen PICC and two participants with triple lumen PICCs). Age, gender, weight, mobility, infusion type and previous thrombus were not associated with increased risk of upper-extremity thrombus. Larger PICC diameter was associated with increased risk of thrombus (RR 10.57; p= 0.02; 95% CI 1.48-75.36).

Conclusions  

Although this research needs to be replicated using a larger sample size, it does suggest that larger PICC diameter increases the risk of thrombus. When requesting PICCs for cancer patients, clinicians should consider requesting the smallest diameter PICC (fewer lumens) that meets the treatment needs of the patient to reduce the risk of thrombus.