Narrative review of PICC related deep vein thrombosis

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“Although 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 in this condition” Fallouh et al (2015).

Reference:

Fallouh, N., McGuirk, H.M., Flanders, S.A. and Chopra, V. (2015) Peripherally Inserted Central Catheter-Associated Deep Vein Thrombosis: A Narrative Review. The American Journal of Medicine. February 16th. [epub ahead of print].

Abstract:

BACKGROUND: Although 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 in this condition.

METHODS: A 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.

RESULTS: The incidence of PICC-DVT varied between 2-75% according to study population, testing modality and threshold for diagnosis. Studies evaluating the role 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 deep venous thrombosis. Anticoagulation with low-molecular weight heparin or warfarin for at least three months represents mainstay of treatment. The role of pharmacologic prophylaxis and screening in PICC-DVT is unclear at this time.

CONCLUSIONS: PICC-DVT is common, costly and morbid. Available evidence provides guidance for diagnosis, treatment and prevention of this condition.

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