Central Catheter-related Deep Vein Thrombosis Research Articles

Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods

BackgroundPeripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. MethodsProspectively collected data from patients that received peripherally inserted central catheters at 52 Michigan hospitals were analyzed. The method used to confirm tip confirmation at insertion and deep vein thrombosis outcomes were extracted from medical records. Multivariate models (accounting for the clustered nature of the data) were fitted to assess the association between peripherally inserted central catheter-related deep vein thrombosis and method of tip confirmation (electrocardiographic vs radiographic imaging). ResultsA total of 42,687 peripherally inserted central catheters (21,098 radiology vs 21,589 electrocardiographic) were included. Patients receiving electrocardiographic-confirmed peripherally inserted central catheters had fewer comorbidities compared with those that underwent placement via radiology. Overall, deep vein thrombosis occurred in 594 (1.3%) of all peripherally inserted central catheters. Larger catheter size (odds radio [OR] 1.32; 95% confidence interval [CI], 0.93-1.90 per unit increase in gauge), history of deep vein thrombosis, and cancer were associated with increased risk of deep vein thrombosis (OR 2.00; 95% CI, 1.65-2.43 and OR 1.62; 95% CI, 1.16-2.26, respectively) using logistic regression. Following adjustment, electrocardiographic guidance was associated with a significant reduction in peripherally inserted central catheter-related deep vein thrombosis compared with radiographic imaging (OR 0.74; 95% CI, 0.58-0.93; P = .0098). ConclusionThe use of electrocardiography to confirm peripherally inserted central catheter tip placement at the cavoatrial junction was associated with significantly fewer deep vein thrombosis events than radiographic imaging. Use of this approach for peripherally inserted central catheter insertion may help improve patient safety, particularly in high-risk patients.

Peripherally inserted central catheter-related thrombosis rate in modern vascular access era-when insertion technique matters: A systematic review and meta-analysis.

Technical factors at the moment of catheter insertion might have a role in peripherally inserted central catheter-related thrombotic risk. We performed a systematic review and meta-analysis to define the actual rate of peripherally inserted central catheter-related symptomatic deep vein thrombosis in patients in whom catheter insertion was performed according to ultrasound guidance, appropriate catheter size choice, and proper verification of tip location. We searched Medline, Embase, and Cochrane Library. Only prospective observational studies published in peer-reviewed journals after 2010 up to November 2018 reporting peripherally inserted central catheter-related deep vein thrombosis rate were included. All studies were of adult patients who underwent peripherally inserted central catheter insertion. Results were restricted to those studies which included in their methods ultrasound guidance for venipuncture, catheter tip location, and a catheter size selection strategy. Random-effect meta-analyses and arcsine transformation for binomial data were performed to pool deep vein thrombosis weighted frequencies. Of the 1441 studies identified, 15 studies involving 5420 patients and 5914 peripherally inserted central catheters fulfilled our inclusion criteria. The weighted frequency of peripherally inserted central catheter-related deep vein thrombosis was 2.4% (95% confidence interval = 1.5-3.3) and remained low in oncologic patients (2.2%, 95% confidence interval = 0.6-3.9). Thrombotic rate was higher in onco-hematologic patients (5.9%, 95% confidence interval = 1.2-10). Considerable heterogeneity (I2 = 74.9) was observed and all studies were considered at high risk of attrition bias. A proper technique is crucial at the moment of peripherally inserted central catheter insertion. Peripherally inserted central catheter-related deep vein thrombosis rate appears to be low when evidence-based technical factors are taken into consideration during the insertion procedure.

The Ultrasound Monitoring to the Venous Thromboembolism Associated with Peripherally Inserted Central Catheters in Chemotherapy Patients: A Prospective Cohort Study

ObjectiveTo investigate the incidence of peripherally inserted central catheter–related deep venous thrombosis (PRDVT) and their associated risk factors of PRDVT in the oncological patients who received peripherally inserted central catheters. MethodsThis is a prospective and interventional cohort study; enrolled cancer patients had ultrasound-guided peripherally inserted central catheters and followed up by an intensive ultrasound monitoring protocol for 24 weeks. Vascular color Doppler ultrasound was applicated to the prospective evaluation of thrombus every 2 weeks for each patient. ResultsOf all 406 patients (37,490 catheter days), 30.05% of patients (122/406) developed peripherally inserted central catheter–related deep vein thrombosis, with an incidence of 3.25 per 1000 catheter days. Only 1.23% (5/406) peripherally inserted central catheters were removed because of central line associated blood stream infection or accident. The incidence of asymptomatic PRDVT and symptomatic PRDVT were 26.85% (109/406) and 3.2% (13/406) respectively. ConclusionThe incidence of PRDVT in our hospital was considerable to the published data. Catheter in right upper extremity, tip at subclavian or T 2-4, more than 1 attempt for peripherally inserted central catheter insertion, and radiotherapy were independent predictors of PRDVT in cancer patients. Proactive ultrasound monitoring protocol from insertion to follow-up visits to investigate the incidence of PRDVT in oncological patients should be a routine examination.

Peripherally Inserted Central Catheter-associated Deep Vein Thrombosis: A Narrative Review

BackgroundAlthough common, little is known about factors associated with peripherally inserted central catheter-related deep vein thrombosis (PICC-DVT). To better guide clinicians, we performed a comprehensive literature review to summarize best practices for this condition. MethodsA systematic search of the literature for studies reporting epidemiology, diagnosis, treatment, and prevention of PICC-DVT was conducted. Algorithms for diagnosis and management were compiled using available evidence. ResultsThe incidence of PICC-DVT varied between 2% and 75% according to study population, testing modality and threshold for diagnosis. Studies evaluating the diagnostic utility of clinical symptoms suggested that these were neither sensitive nor specific for PICC-DVT; conversely, ultrasonography had excellent sensitivity and specificity and is recommended as the initial diagnostic test. Although more specific, contrast venography should be reserved for cases with high clinical probability and negative ultrasound findings. Centrally positioned, otherwise functional and clinically necessary PICCs need not be removed despite concomitant DVT. Anticoagulation with low-molecular-weight heparin or warfarin for at least 3 months represents the mainstay of treatment. The role of pharmacologic prophylaxis and screening for PICC-DVT in the absence of clinical symptoms is unclear at this time. ConclusionsPICC-DVT is common, costly and morbid. Available evidence provides guidance for diagnosis, treatment and prevention of this condition.