PB0265 - Prevention of Upper Extremity PICC-associated Thrombosis Using Squeeze Balls in the Inpatient Oncology Setting: Preliminary Findings from a Prospective Single-Arm Non-Randomized Investigation

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Emily M. Harris, MD

Resident Physician
Boston Children's Hospital / Harvard Medical School
Boston, Massachusetts, United States

Co-Author(s)

JF

Julia B. Finkelstein

Director of Quality Improvement and Patient Safety, Department of Urology
Boston Children's Hospital
Boston, Massachusetts, United States
BE

Brittany Esty

Attending Physician, Division of Immunology
Boston Children's Hospital
Boston, Massachusetts, United States
OH

Olha Halyabar

Attending Physician, Rheumatology Program
Boston Children's Hospital
Boston, Massachusetts, United States
CC

Christine E. Cherella

Assistant Clinical Chief, Productivity, Quality, Reliability, and Safety, Division of Endocrinology
Boston Children's Hospital
Boston, Massachusetts, United States
CP

Chase Parsons

Pediatric Hospitalist, Instructor of Pediatrics
Boston Children's Hospital / Harvard Medical School
Boston, Massachusetts, United States
RR

Robert Rosen

Chief Resident in Pediatrics
Boston Combined Residency Program
Boston, Massachusetts, United States
DM

Duncan Morhardt

Assistant Professor of Medicine
Geisel School of Medicine, Dartmouth
Lebanon, New Hampshire, United States
BA

Beverly Aiyanyor

Physician
Boston Children's Hospital / Harvard Medical School
Boston, Massachusetts, United States
DO

Daniel O'Meara

Resident Physician
Boston Children's Hospital / Harvard Medical School
Boston, Massachusetts, United States
SF

Sebastian T. Ferrell

Quality Improvement Data Analyst
Boston Children's Hospital
Boston, Massachusetts, United States
DC

Daniela Ciccolini

Oncology Nurse Practitioner
Boston Children's Hospital
Boston, Massachusetts, United States
EL

Elaine Lambrinos

Pediatric Nurse Practitioner
Boston Children's Hospital
Boston, Massachusetts, United States
ED

Emily Drake

Pediatric Anti-Coagulation Nurse Practitioner
Division of Hematology and Oncology, Boston Children's Hospital and Harvard Medical School
Boston, Massachusetts, United States
KH

Kate E. Humphrey

Associate Medical Director for Patient Safety
Boston Children's Hospital
Boston, Massachusetts, United States
RK

Riten Kumar, MD, MSc

Associate Professor of Pediatrics
Dana-Farber/Boston Children's Cancer and Blood Disorders Center.
Boston, Massachusetts, United States

Background: The incidence of venous thrombo-embolism (VTE) in children has increased by 70-200% over the last two decades with ~80% of thrombosis occurring secondary to central venous catheters (CVCs). Among CVCs, peripherally inserted central catheters (PICCs) have the highest risk of VTE. Sequential compression devices reduce venous stasis in lower extremities, but similar devices are unavailable for upper extremities (UE).

Aims: In this prospective, single-arm study we investigated the use of squeeze balls to encourage UE mobilization in pediatric oncology patients with PICCs to reduce VTE risk.

Methods: The study was approved by the research ethics board. Children (≥4 years) with upper extremity PICCs who met a-priori eligibility criteria were asked to participate. Informed assent was obtained. Enrolled patients were instructed to squeeze the ball 10 times/hour (while awake) with the ipsilateral hand. Patients were followed through their hospitalization. Standard statistical methods were used.

Results: Patient enrollment started in 09/2020. At the time of preliminary analysis (01/2022), 94 patients were screened (figure 1). 33 patients (15 female gender) participated in the study (table 1). Median age at participation was 13 (range: 4-22) years. The most common admission diagnosis was leukemia (n=23; 70%). Most patients had a single lumen PICC (n=20, 60%). Five patients received prophylactic enoxaparin during admission, none of whom developed VTE. Seven (21%) patients had UE ultrasound performed during admission given clinical concerns for VTE. Four (12%) patients developed VTE: two in the ipsilateral arm as PICC placement, and one in the contralateral arm. Two patients had pulmonary embolism. In our preliminary analysis, age, gender, diagnosis (leukemia versus solid tumor), laterality, or prophylactic anticoagulation were not significantly associated with VTE (p-value >0.05).

Conclusion(s): In this preliminary analysis, 2/33 (6%) of pediatric oncology patients with an upper extremity PICC using a squeeze ball regimen developed a PICC-associated thrombosis. We continue to actively enroll patients.