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

Abstract

Summary Background 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. Methods 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. Results 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. Conclusions 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.

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

“…Contemporary Patterns and Predictors' [1]. Drs Kang, Li and Chen note that our findings related to the association between PICC gauge, cancer and deep vein thrombosis (DVT) are in accord with the prior literature [2].…”

Central venous catheter–related thrombosis

“…14,[17][18][19][22][23][24][25] Features of the CVC associated with increased rates of CRT include: PICC Ͼ centrally inserted catheter Ͼ implanted port, 14,[17][18][19] jugular Ͼ subclavian, 24 size of the catheter relative to the size of the vein, 3,14,20 and position of the catheter tip. 1,26 Among 184 critical care patients, placement of a CVC in the jugular vein was associated with a 6.8-fold higher rate of CRT per 1000 catheter-days than subclavian access.…”

“…16 Patients whose CVC tip was above the proximal superior vena cava (SVC) were 7 times more likely to develop CRT than those whose tip was in the SVC near the right atrium. 26 Patient factors associated with increased rates of CRT include the presence of cancer, 14,19,20,25 previous history of DVT, 14,17 and systemic or catheter-related infection. 5 Cancer, particularly extensive or metastatic disease, has consistently been shown to be one of the strongest risk factors for CRT.…”

A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial

“…Patients with PICC catheter sizes 5 French and 6 French were found to have an earlier onset of VTE than patients with smaller size PICC lines. 11 Evans and colleagues found a correlation between catheter size and incidence of VTE when progressing from smaller 4 French (0.6%) to 5-Fr (2.9%) to larger 6 French (8.8%) PICC lines. 6 Location of vein chosen for PICC insertion has been shown as a contributing factor for VTE.…”

“…Risk factors for the development of CLABSI include the number of times the line is manipulated, location of insertion, 8 and prolonged dwell time, 9,10 and the development of thrombus. 11 Trauma and critical care patients, as well as those admitted with immune suppression are at an increased risk for CLABSI. 12,13 In addition to the risk of CLABSI associated with PICC lines, upper extremity venous thromboembolism (VTE) is another potential complication.…”