Intravenous literature: Fletcher, J.J., Stetler, W. and Wilson, T.J. (2011) The clinical significance of peripherally inserted central venous catheter-related deep vein thrombosis. Neurocritical Care. 15(3), p.454-60.
BACKGROUND:Â Peripherally inserted central venous catheters (PICCs) are being increasingly utilized in hospitalized patients as alternatives to centrally inserted central venous catheters (CICVCs). However, concern exists over the risk of PICC-related large vein thrombosis (PRLVT). The incidence rate and significance of symptomatic PRLVT in critically ill patients admitted to the neurological intensive care unit (ICU) is not known.
METHODS:Â Retrospective descriptive study of consecutive PICCs placed in critically ill patients admitted to a tertiary care neurological ICU between March 2008 and February 2010. Symptomatic PRVLT was defined as an event that prompted Duplex ultrasound of the ipsilateral extremity in which an acute, proximal large vein thrombosis was confirmed in association with the PICC or confirmed within 5 days of PICC removal. Incidence rate of PRLVT and catheter-related complications were calculated per “line” (catheter). Descriptive statistics were performed with two-sample, and t-tests for age and categorical variables were assessed by Chi-square test or Fishers exact test as appropriate.
RESULTS:Â Four hundred and seventy-nine lines were placed during the study period with 39 developing a symptomatic PRLVT (incidence rate = 8.1%). Male gender was associated with development of a thrombosis (P = 0.02), but size (P = 0.21) and location of catheter were not (P = 0.30). Median line dwell time was 12 days (IQR 16) with a dwell time of 8 days (IQR 9) until thrombosis diagnosis. Pulmonary embolus attributed to PRLVT occurred in 1.3% of line placements and 15% of symptomatic PRLVT. The majority of patients had their line removed. In addition, some patients also had anticoagulation initiated or a superior vena cava filter placed.
CONCLUSIONS:Â Symptomatic PRLVT is not uncommon in critically ill patients admitted to the neurological ICU. Future research should focus on indentifying modifiable risk factors for PRLVT and on comparing major cumulative complication rates between PICCs and CICVCs.