Recent diagnosis of cancer and PICC gauge are associated with PICC-DVT

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#IVTEAM #Intravenous literature: Chopra, V., Ratz, D., Kuhn, L., Lopus, T., Lee, A. and Krein, S. (2014) Peripherally Inserted Central Catheter-Related Deep Vein Thrombosis: Contemporary Patterns and Predictors. Journal of Thrombosis and Haemostasis. March 10th. [epub ahead of print].

Abstract:

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: Retrospective cohort study of adults who underwent PICC placement between January 2009- October 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 (OR) and hazard ratios (HR) with corresponding 95% confidence intervals (CI) 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 [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) 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. Policies and procedural oversights in these areas appear necessary to prevent PICC-DVT.

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