Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: A nested case–control study. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Chopra, Vineet; Fallouh, Nabil; McGuirk, Helen; Salata, Brian; Healy, Christina; Kabaeva, Zhyldyz; Smith, Shawna; Meddings, Jennifer; Flanders, Scott A.
• Is Part Of: Thrombosis research. Volume 135:Issue 5(2015)
• Page Start: 829
• Page End: 834
• Publication Date: 2015-05
• Subjects: Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2015.02.012
• Languages: English
• ISSNs: 0049-3848

Abstract

<abstract abstract-type="author" id="ab0005"> <title id="st0005">Abstract</title> <sec> <title id="st0010">Background</title> <p id="sp0005">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.</p> </sec> <sec> <title id="st0015">Objective</title> <p id="sp0010">To determine patterns, risk factors and treatment related to PICC-DVT in hospitalized patients.</p> </sec> <sec> <title id="st0065">Design, Setting & Patients</title> <p id="sp0015">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 <italic>a priori</italic>, multivariable logistic regression models were fit to the outcome of PICC-DVT, comparing cases to controls.</p> </sec> <sec> <title id="st0020">Results</title> <p id="sp0020">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 <italic>in situ</italic> (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).</p> </sec> <sec> <title id="st0025">Conclusion</title> <p id="sp0025">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.</p> </sec> </abstract>