Incidence of Deep Venous Thrombosis (DVT) in Head and Neck Cancer Patients Receiving IV Fluids (IVF) via Peripheral IV (PIV) Compared to Central Venous Catheter

Purpose/Objective(s)

Venous thromboembolism (VTE) is a common complication among cancer patients with a reported incidence close to 15% per year.^(1-3) One study found a VTE risk of 18.3% in the head and neck (H&N) cancer population using the Caprini risk assessment model.⁴ Up to 66% of VTE occurring in the upper extremity are due to intravenous catheters.⁵ This implies that recurring IV access for hydration would induce a clinically significant level of endothelial inflammation resulting in a higher risk of VTE. Therefore, patients with H&N cancer undergoing chemoradiotherapy who require repeated IV insertion for IV hydration appear to be at an increased risk for DVTs. We wanted to estimate the risk of DVT among H&N cancer patients undergoing regular IV hydration via peripheral IV as opposed to central venous catheter (CVC) to see if CVC use reduces the risk of DVT.

Materials/Methods

A retrospective database was created for patients at our institution from CY2019 to CY2020 who had a diagnosis of H&N cancer. We recorded the type of cancer, presence and location of DVT, if they were receiving IVF and if so, via CVC or PIV, and treatment received (chemo +/- XRT). We analyzed the number of patients who developed DVT and evaluated if there was a difference in incidence of DVT between those who received IVF through PIV or CVC.

Results

Out of 72 patients with H&N cancer, 7 were found to have DVT (9.7%). 57% of patients developed upper extremity DVT and 43% lower extremity. Two with DVT also had pulmonary embolus. 57% of patients were receiving IVF 2-3 times/week via PIV, 14% were receiving IVF through CVC, and the remaining 29% did not receive IVF. Out of these 7 patients who developed DVT, 6 (85.7%) were receiving both chemotherapy and radiation at the time of DVT, and the remaining patient was not receiving cancer treatment.

Conclusion

The data show a significant incidence of VTE among H&N cancer population. The preliminary data also shows an increased incidence of DVT among those receiving IVF via PIV compared to CVC, which supports a change of hydration protocol from PIV to CVC. Further prospective data will be obtained to add to the analysis.