Peripherally Inserted Central Catheter (PICC) Associated Upper Extremity Deep Vein Thrombosis (UEDVT) - Patterns, Predictors, and Outcomes

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 1001A ◽  
Author(s):  
Avanthika Wickramarathne ◽  
Gary Wahl
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Vein Thrombosis ◽  
Deep Vein

Peripherally inserted central catheter–related thrombosis rate in modern vascular access era—when insertion technique matters: A systematic review and meta-analysis

2019 ◽  
Vol 21 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Paolo Balsorano ◽  
Gianni Virgili ◽  
Gianluca Villa ◽  
Mauro Pittiruti ◽  
Stefano Romagnoli ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Confidence Interval ◽  
Meta Analysis ◽  
Catheter Insertion ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Vein Thrombosis ◽  
The Moment ◽  
Deep Vein ◽  
Thrombosis Rate

Background: Technical factors at the moment of catheter insertion might have a role in peripherally inserted central catheter–related thrombotic risk. We performed a systematic review and meta-analysis to define the actual rate of peripherally inserted central catheter–related symptomatic deep vein thrombosis in patients in whom catheter insertion was performed according to ultrasound guidance, appropriate catheter size choice, and proper verification of tip location. Methods: We searched Medline, Embase, and Cochrane Library. Only prospective observational studies published in peer-reviewed journals after 2010 up to November 2018 reporting peripherally inserted central catheter–related deep vein thrombosis rate were included. All studies were of adult patients who underwent peripherally inserted central catheter insertion. Results were restricted to those studies which included in their methods ultrasound guidance for venipuncture, catheter tip location, and a catheter size selection strategy. Random-effect meta-analyses and arcsine transformation for binomial data were performed to pool deep vein thrombosis weighted frequencies. Results: Of the 1441 studies identified, 15 studies involving 5420 patients and 5914 peripherally inserted central catheters fulfilled our inclusion criteria. The weighted frequency of peripherally inserted central catheter–related deep vein thrombosis was 2.4% (95% confidence interval = 1.5–3.3) and remained low in oncologic patients (2.2%, 95% confidence interval = 0.6–3.9). Thrombotic rate was higher in onco-hematologic patients (5.9%, 95% confidence interval = 1.2–10). Considerable heterogeneity (I2 = 74.9) was observed and all studies were considered at high risk of attrition bias. Conclusions: A proper technique is crucial at the moment of peripherally inserted central catheter insertion. Peripherally inserted central catheter–related deep vein thrombosis rate appears to be low when evidence-based technical factors are taken into consideration during the insertion procedure.

Managing Peripherally Inserted Central Catheter Thrombosis Risk: A Guide for Clinical Best Practice

2011 ◽  
Vol 16 (3) ◽  
pp. 144-147 ◽  
Author(s):  
Britt M. Meyer
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Practice ◽  
Ultrasound Guidance ◽  
Vena Cava ◽  
Outer Diameter ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Vein Thrombosis ◽  
Thrombosis Risk ◽  
Deep Vein

Abstract Purpose: The purpose of this study was to evaluate the effectiveness of clinical practice changes in an effort to reduce peripherally inserted central catheter thrombosis risk. Patients and Method: A retrospective analysis of adult patients in the acute care setting. Results: A total number of 1307 charts of patients who received PICCs were reviewed encompassing the months of January 2008, October 2008 and August 2010. During the period from January 2008 to October 2008, clinical practice changes were made to include the use of ultrasound guidance. Ensuring catheter tip termination in the superior vena cava with the addition of ultrasound technology as an insertion practice combined to decrease symptomatic PICC related deep vein thrombosis rates from 4.8 % to 2.9%. During the period from October 2008 to August 2010, an additional practice was introduced that involved measurement and documentation of vein diameters(without the use of a tourniquet) prior to all PICC insertion procedures. Deep vein thrombosis (DVT) rates dropped further from 2.9 % to 1.4 % during this period. Conclusion: Obtaining central tip location and using ultrasound guidance for PICC placement are effective in reducing PICC related DVT. Additionally, routine measurement of vein diameters in their native state and use of that information to ensure that the vessel diameter is at least twice the outer diameter of the catheter is an effective practice to reduce DVT rates and reduce thrombosis risk.

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