title: Incidence of deep vein thrombosis associated with peripherally inserted central catheters in adults with cystic fibrosis.
abstract: OBJECTIVE
  Peripherally inserted central catheters (PICCs) are commonly used in patients with cystic fibrosis (CF) to administer intravenous antibiotics for pulmonary exacerbations. The aim of this study was to determine the incidence of PICC-related deep vein thrombosis (DVT) in a large group of adults with CF with and without Burkholderia cepacia complex (BCC) infection, and to investigate the association between PICC-related DVT and preinsertion serum erythrocyte sedimentation rate (ESR).
  
  
  METHODS
  This was a retrospective cohort study of all patients with PICCs inserted at a single institution during a 6-year period. A total of 524 adults with CF were treated in the clinic over this time period, with 147 (28.1%) having one or more PICCs inserted. Symptomatic venous thromboses were confirmed by Doppler ultrasound. Patients were classified as BCC-positive or BCC-negative, and preinsertion blood test results were analyzed.
  
  
  RESULTS
  A total of 376 PICCs were inserted in 147 patients, with 12 patients (8.2%) developing symptomatic PICC-related DVT. Five additional subjects (3.4%) were diagnosed with asymptomatic PICC-related DVT. BCC-positive patients had a higher overall incidence of PICC-related DVT (20.9%) than BCC-negative patients (7.7%; P = .02). Preinsertion serum ESRs were higher in patients who subsequently developed PICC-related DVT (mean +/- SE, 54.4 mm/h +/- 7.2) compared with those without DVT (38.4 mm/h +/- 2.5; P < .05).
  
  
  CONCLUSIONS
  The incidence of symptomatic PICC-related DVT was 3.7% per PICC. BCC-positive patients had a higher overall incidence of DVT than BCC-negative patients. Higher preinsertion ESRs in patients who developed PICC-related DVT suggest that systemic inflammation may be a risk factor for subsequent PICC-related DVT.
authors.affiliation: Toronto Adult Cystic Fibrosis Clinic, St Michael's Hospital, University of Toronto, Ontario, Canada. edward.nash@heartofengland.nhs.uk
authors.forename: Edward F
authors.initials: EF
authors.lastname: Nash
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Helm
authors.forename: Anne
authors.initials: A
authors.lastname: Stephenson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tullis
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology*