title: Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients.
abstract: BACKGROUND
  Peripherally inserted central venous catheters (PICC) have been proposed as an alternative to central venous catheters (CVC). The aim of this study was to determine the thrombosis rate in relation to PICC placement in patients discharged from the intensive care unit (ICU).
  
  
  METHODS
  Data of patients admitted to the ICU (Careggi Teaching Hospital, Florence, Italy; January-August 2008) and discharged with a central venous device were sequentially studied. During the first 4 months, CVCs were used (CVC group), whereas during the last 4 months, PICCs were used (PICC group). Demographic/clinical and catheter-related data were collected. Intensivists performed Doppler examination at ICU discharge and 7, 15, and 30 days after placement.
  
  
  RESULTS
  Data of 239 patients were analyzed (125 of CVC group, 114 of PICC group). A total of 2,747 CVC-days and 4,024 PICC-days of observation were included. Patient characteristics were comparable between groups. Patients with PICC had a significantly higher incidence rate of deep venous thrombosis (DVT) than patients with CVC (27.2 vs. 9.6%, P = 0.0012). The rate of DVT/1,000 catheter days was 4.4 for CVCs and 7.7 for PICCs. Eighty percent of DVTs occurred within 2 weeks after insertion. Binary logistic analysis showed a two-fold increased risk for women and a three-fold increased risk when using the left basilic vein in the PICC group.
  
  
  CONCLUSIONS
  In our post-critically ill population, PICCs were associated with a higher rate of DVT complications than CVCs. Routine ultrasound surveillance for the first 2 weeks after patient discharge from the ICU with a PICC and preferential use of CVC for these patients may be warranted.
authors.affiliation: Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Viale Morgagni 85, 50134 Florence, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Bonizzoli
authors.forename: Stefano
authors.initials: S
authors.lastname: Batacchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cianchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zagli
authors.forename: Francesco
authors.initials: F
authors.lastname: Lapi
authors.forename: Valentina
authors.initials: V
authors.lastname: Tucci
authors.forename: Giacomo
authors.initials: G
authors.lastname: Martini
authors.forename: Simona
authors.initials: S
authors.lastname: Di Valvasone
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*