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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

1Boston Children's Hospital / Harvard Medical School, Boston, Massachusetts, United States, 2Boston Children's Hospital, Boston, Massachusetts, United States, 3Boston Combined Residency Program, Boston, Massachusetts, United States, 4Geisel School of Medicine, Dartmouth, Lebanon, New Hampshire, United States, 5Division of Hematology and Oncology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States, 6Harvard Medical School, Boston, Massachusetts, United States

Abstract Number: PB0265

Meeting: ISTH 2022 Congress

Theme: Pediatrics » Thrombosis in Neonates and Children

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.

Figure 1

Consort flow diagram showing patient enrollment

Table 1

Patient Characteristics

To cite this abstract in AMA style:

Harris E, Finkelstein J, Esty B, Halyabar O, Cherella C, Parsons C, Rosen R, Morhardt D, Aiyanyor B, O'Meara D, Ferrell S, Ciccolini D, Lambrinos E, Drake E, Humphrey K, Kumar R. 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 [abstract]. https://abstracts.isth.org/abstract/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/. Accessed October 2, 2023.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/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/