The Effect of Laterality on Venous Thromboembolism Formation after Peripherally Inserted Central Catheter Placement

Abstract

The use of peripherally inserted central venous catheters (PICCs) has become widespread in hospital medicine. PICCs are preferentially placed on the right side due to anatomic ease of insertion into the superior vena cava. However, no data exists examining whether this practice is also protective against symptomatic venous thrombosis. The purpose of this study is to assess placement of right-sided versus left-sided PICCs and the resulting rates of venous thromboembolism (VTE) in a community teaching hospital. A retrospective analysis was performed of 798 sequential PICCs placed in our community teaching hospital in 2008. Indication for PICC placement, laterality of PICC placement, and signs and symptoms leading to ultrasound assessment were examined as well as the resulting VTE location. Six hundred and seventy two patients had a total of 798 PICCs placed over the course of the year, 568 of these were right-sided catheters, and 230 were left-sided catheters. Forty-nine of these patients required 68 Doppler ultrasounds within 30 days of PICC placement. Of these ultrasounds, 47 (8.27%) followed right-sided PICCs and 21 (9.13%) followed left-sided PICCs (OR 0.90, 95% CI 0.52-1.54). VTE events were documented in 1.23% of right-sided PICCs and 1.30% of left-sided PICCs (OR 0.94, 95% CI 0.24-3.68). The overall incidence of this complication was 1.25%. Mean time until discovery of the thrombus was 13.6 days. Laterality of PICC placement is not significantly associated with symptomatic VTE formation. The overall rate of thrombosis in our study is comparable to that of previous studies.