经外周静脉置入中心静脉导管相关上肢静脉血栓的研究进展

Research progress on peripherally inserted central catheter-related upper extremity venous thrombosis

经外周静脉置入中心静脉导管(peripherally inserted central venous catheter,PICC)相关上肢静脉血栓形成是PICC置入后,在导管走行的静脉内及相连静脉内形成的血栓,是PICC的严重并发症之一,可引起肺栓塞。常见危险因素有肿瘤、既往血栓病史、导管尖端异位等。临床上可有静脉炎和栓塞的表现,诊断首选彩色多普勒超声检查。不推荐直接拔除导管,治疗上如无禁忌首选抗凝治疗。抗凝期间若导管尖端位置正常、导管功能良好,患者仍需要静脉治疗,导管可以继续使用。通常早期诊疗可以取得较好的临床效果,不推荐常规预防性抗凝。对于PICC相关无症状血栓的诊疗尚无明确指南,有待于前瞻性随机对照研究进一步验证。

Peripherally inserted central venous catheter(PICC)-related upper extremity venous thrombosis(UEVT)is defined as upper extremity venous thrombosis within the veins where PICCs were placed or adjacent to and may result in pulmonary embolism.Malignancies,previous history of venous thrombosis and malposition are common risk factors for PICC-UEVT.Once patients demonstrate clinical manifestations of phlebitis and thrombosis,such as swelling,pain and tenderness at the PICC site,venous duplex ultrasonography is the first choice for diagnosing PICC-UEVT.According to American College of Chest Physicians guidelines,it's not recommended to remove PICCs upon detection of PICC-UEVT.The first-line treatment is to administer systemic anticoagulants while keeping the catheter in place,unless any contraindications.PICCs could continue to be used during anticoagulation therapy,suppose that catheter tip remains well placed and functions as normal.With early diagnosis and standard anticoagulant treatment,a better clinical outcome could be achieved.Prophylactic anticoagulation is not routinely recommended per guidelines.Recommendation for asymptomatic PICC-related thrombosis is still absent and warrants further prospective studies with large sample size.