Reducing PICC diameter to a maximum of 5Fr is associated with a significant decrease in the rate of PICC-associated DVT


Intravenous literature: Evans, R.S., Sharp, J.H., Linford, L.H., Lloyd, J.F., Woller, S.C., Stevens, S.M., Elliott, C.G., Tripp, J.S., Jones, S.S. and Weaver, L.K. (2012) Reduction of Peripherally Inserted Central Catheter Associated Deep Venous Thrombosis.
Chest. Aug 1. Epub ahead of print].


BACKGROUND: As peripherally inserted central catheter (PICC) use has increased, so has the upper extremity deep venous thrombosis (DVT) rate. PICC diameter may pose the most modifiable risk for PICC-associated DVT.

METHODS: A three year prospective observational study of all PICC insertions by a specially trained and certified team using a consistent and replicable approach was conducted at a 456-bed, level-one trauma and tertiary referral hospital during January 1, 2008 through December 31, 2010. An intensified effort by the PICC team in 2010 was introduced to discuss and reach interdisciplinary consensus on the need for each lumen of the PICC and a change to smaller diameter 5F triple-lumen PICC.

RESULTS: Significantly more 4F single-lumen PICC were used during 2010 (n = 470) compared to 2008 and 2009 (n = 338, 382; p < 0.0001). 5F triple-lumen PICC used in 2010 were found to have similar DVT rates as 5F double-lumen and lower rates than 6F triple-lumen catheters used in 2008 and 2009. The PICC-associated DVT rate was significantly lower (1.9% vs. 3.0%,; p < 0.04) in 2010 compared to 2008 and 2009. The cost and length of stay attributable to PICC-associated DVT was $15,973 and 4.6 days.

CONCLUSIONS: A significant increase in the use of single lumen PICC in addition to the institutional adoption of smaller 5F triple lumen PICC was associated with a significant decrease in the rate of PICC-associated DVT.

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