Peripherally inserted central catheter‐related deep vein thrombosis: contemporary patterns and predictors

V Chopra,D Ratz,L Kuhn,T Lopus,A Lee,S Krein

doi:10.1111/jth.12549

Abstract

Despite growing use, peripherally inserted central catheters (PICCs) are associated with risk of deep vein thrombosis (DVT). We designed a study to determine patient, provider and device factors associated with this outcome. This was a retrospective cohort study of adults who underwent PICC placement between 1 June 2009 to 30 June 2012. Symptomatic PICC-associated DVT was confirmed by ultrasound. Because PICCs are also recognized risk factors for lower-extremity DVT, lower-extremity DVT occurring while the PICC was in situ was included. Multivariable logistic and Cox-proportional hazards regression models were fit to examine the association between covariates specified a priori and PICC-DVT. Odds ratios (ORs) and hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were generated. Of 966 unique PICC placements, 33 patients developed symptomatic PICC-associated DVT and 9 developed lower-extremity DVT, accounting for 42 thrombotic events. On bivariate analysis, recent diagnosis of cancer, interventional radiology placement, chemotherapy administration, number of lumens and PICC-gauge were associated with PICC-DVT. Following multivariable adjustment, recent cancer diagnosis (OR 1.95 [95% CI 1.01-3.76]) and PICC gauge (HR 2.21 [95%CI 1.04-4.70] and HR 3.56 [95%CI 1.31-9.66] for 5-Fr and 6-Fr PICCs, respectively) remained associated with thrombosis. Recent diagnosis of cancer and PICC gauge are associated with PICC-DVT. These findings have important clinical ramifications and suggest that placement of large gauge PICCs or PICCs in patients with cancer may provoke thrombosis. Improved policies and procedural oversights in these areas appear necessary to prevent PICC-DVT.

Highlights

The use of peripherally inserted central catheters (PICCs) has grown rapidly in the United States [1]. Because these devices are inserted in the arm and avoid many of the iatrogenic, mechanical complications associated with central venous catheter insertion in the neck or chest, they are often considered safer than their traditional counterparts
PICC-deep vein thrombosis (DVT) often leads to interruptions in treatment, creating a conundrum for providers who rely on these devices for venous access, while increasing length of stay and cost [5.] This adverse event leads to significant scarring and obliteration of upper extremity deep veins, impairing venous return and subsequent venous access
DVTs were classified as being PICC-associated when B-mode or Doppler ultrasound revealed the presence of thrombus in the deep veins of the arm while a PICC was in situ

Summary

Introduction

The use of peripherally inserted central catheters (PICCs) has grown rapidly in the United States [1]. With the advent of vascular access nursing teams, who provide high rates of insertion success and evidence-based insertion and maintenance, PICCs have become more accessible to hospitals across the country, often serving as a bridge for intravenous therapies from the inpatient to the outpatient setting [2]. Despite these advantages, PICCs are increasingly associated with deep vein thrombosis of the arm (PICCDVT), a complication that has important consequences [3,4]. This article is a U.S Government work and is in the public domain in the USA

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Discussion

Conclusion