MedicalResearch.com Interview with:
Mary A.M. Rogers, PhD, MS
Research Associate Professor
Research Director, Patient Safety Enhancement Program
Department of Internal Medicine
University of Michigan
Ann Arbor, MI
MedicalResearch.com: What is the background for this study?
Response: Peripherally inserted central catheters (PICCs) are commonly used for vascular access in hospitalized patients. Previous studies have shown that PICCs of larger gauge (diameter) increase the risk of developing venous thromboembolism (blood clots in the deep veins that sometimes travel to the lung). Red blood cell transfusion is also known to increase the risk of venous thromboembolism. Because PICCs are often used to transfuse blood, we designed a study to investigate whether the method of transfusion delivery influences the risk of developing venous thromboembolism.
MedicalResearch.com: What are the main findings?
Response: We studied 10,604 hospitalized patients from 47 hospitals. All of the patients had a PICC. We compared the rates of venous thromboembolism in patients who had transfusions through different types of catheters.
The main finding was that patients who had a red blood cell transfusion through a multi-lumen PICC had higher rates of venous thromboembolism. The rates were lower in those who had a transfusion through a peripheral intravenous line or through a single-lumen PICC. It wasn’t the gauge of the PICC or the length of the PICC that imparted this risk; it was the number of lumens.
MedicalResearch.com: What should readers take away from your report?
Response: Clinicians should consider using a peripheral intravenous catheter for red blood cell delivery when possible in patients with multi-lumen PICCs or, if not feasible, there should be careful monitoring for thrombosis in patients transfused through multi-lumen PICCs.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Because multi-lumen PICCs are often used to administer various medications and fluids, this may be a clue that giving red blood cells simultaneously with other fluids may be a concern; another study is necessary to examine this in further detail. The Food and Drug Administration indicates that red blood cell units should not be mixed with other fluids during transfusion, with the exception of normal saline. Earlier animal and laboratory studies show that blood sometimes clots when certain medications or other fluids are given with red blood cells. More study is needed regarding which methods of delivery provide the greatest safety for patients who require intravenous fluids
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Lancet Haematol. 2016 Nov 3. pii: S2352-3026(16)30132-6. doi: 10.1016/S2352-3026(16)30132-6. [Epub ahead of print]
Association between delivery methods for red blood cell transfusion and the risk of venous thromboembolism: a longitudinal study.
Rogers MA1, Blumberg N2, Bernstein SJ3, Flanders SA3, Chopra V3.
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