Clinical question: What is the rate of symptomatic upper-extremity DVT (UEDVT), and what are the predictors of UEDVT development in a cohort of hospitalized patients with peripherally inserted central catheters (PICCs)?
Background: PICCs are used in hospitalized patients and increase VTE risk. Investigators in this study sought to determine the incidence of VTE associated with PICCs in a cohort of hospitalized patients.
Study design: Retrospective chart review.
Setting: University-affiliated community hospital in Memphis, Tenn.
Synopsis: Over a three-month period, 954 PICCs were placed in 777 patients. Ninety percent of the patients were placed due to poor venous access. Thirty-eight (4.89%) developed at least one VTE, giving a rate of 5.10 VTEs per 1,000 PICC-days; 27 (3.47%) developed UEDVT, giving a rate of 3.65 UEDVTs per 1,000 PICC-days; eight (1.03%) had PE. Patients with VTE had a significantly longer LOS (26 days vs. 15.8 days), and average PICC-days were significantly longer in patients with VTE (13 days vs. 9 days).
In multivariate analysis, the strongest predictors of PICC-associated VTE were previous history of VTE (OR 10.83, 95% CI, 4.89-23.95), PICC tip in noncentral location (OR 2.61, 95% CI, 1.28-5.35), and duration of stay in 10-day increments (OR 1.21, 95% CI, 1.07-1.37).
This study likely underestimates the rate of VTE because symptomatic VTE specifically was assessed. This study and other studies indicate that VTE occurrence in patients with PICC lines is significant; more judicious use of PICC lines is needed and minimizing the length of time PICC lines are in place is important.
Bottom line: In hospitalized patients with PICC lines, previous history of VTE, noncentral location of the PICC tip, and duration of placement are significant predictors of VTE.
Citation: Lobo BL, Vaidean G, Broyles J, Reaves AB, Shorr RI. Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters. J Hosp Med. 2009;4(7):417-422.
Reviewed for TH eWire by Sameer Badlani, MD, Stacy S. Banerjee, MD, Alan J. Jung, MD, Elizabeth Marlow, MD, MPP, Valerie G. Press, MD, MPH, Milda R. Saunders, MD, MPH, Nilam J. Soni, MD, Srilaxmi Tumuluri, MD, Section of Hospital Medicine, University of Chicago
For more reviews of HM-related literature, visit our Web site.