Highlights
- •Risk factors for PICC DVT were modeled in a nested case–control design.
- •Granular electronic medical records and logstic regression models were used.
- •PICC-DVT was associated with prior VTE, surgery of any duration, and PICC diameter.
- •Aspirin and statin therapy during hospitalization reduced risk of PICC-DVT.
- •Pharmacologic VTE prophylaxis trended towards reducing risk of PICC-DVT.
Abstract
Background
Peripherally inserted central catheters (PICCs) are associated with upper extremity-deep
vein thrombosis (DVT). However, patterns, risk factors and treatment associated with
this event remain poorly defined.
Objective
To determine patterns, risk factors and treatment related to PICC-DVT in hospitalized
patients.
Design, Setting & Patients
Between 2012–2013, consecutive cases of ultrasound-confirmed, symptomatic PICC-DVT
were identified. For each case, at least two contemporaneous controls were identified
and matched by age and gender. Patient- and device-specific data were obtained through
electronic-medical records. Using variables selected a priori, multivariable logistic regression models were fit to the outcome of PICC-DVT, comparing
cases to controls.
Results
909 adult hospitalized patients (268 cases, 641 controls) were included in the study.
Indications for PICC placement included long-term intravenous antibiotic therapy (n = 447; 49.1%), in-hospital venous access for blood draws or infusion of medications
(n = 342; 44.2%), and total parenteral nutrition (n = 120; 6.7%). Patients with PICC-DVT were more likely to have a history of venous thromboembolism
(OR 1.70, 95% CI = 1.02-2.82) or have undergone surgery while the PICC was in situ (OR 2.17, 95%CI = 1.17-4.01 for surgeries longer than two hours). Treatment for PICC-DVT varied and
included heparin bridging, low molecular weight heparin only and device removal only;
the average duration of treatment also varied across these groups. Compared to 4-Fr
PICCs, 5- and 6-Fr PICCs were associated with greater risk of DVT (OR 2.74, 95%CI = 0.75-10.09 and OR 7.40 95%CI = 1.94-28.16, respectively). Patients who received both aspirin and statins were less
likely to develop PICC-DVT than those that received neither treatment (OR 0.31, 95%CI = 0.16-0.61). Receipt of pharmacological DVT prophylaxis during hospitalization showed
a non-significant trend towards reduction in risk of PICC-DVT (OR = 0.72, 95%CI = 0.48-1.08).
Conclusion
Several factors appear associated with PICC-DVT. While some of these characteristics
may be non-modifiable, future studies that target potentially modifiable variables
to prevent this adverse outcome would be welcomed.
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Article info
Publication history
Published online: February 20, 2015
Accepted:
February 13,
2015
Received in revised form:
February 10,
2015
Received:
November 12,
2014
Footnotes
☆Funding: No funding was received for this study. Dr. Chopra is supported by a career development award (1-K08-HS022835-01) from the Agency of Healthcare Research and Quality.
Identification
Copyright
Published by Elsevier Inc.
