title: Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients.
abstract: OBJECTIVE
  Using Virchow's triad as a framework, we sought to identify risk factors independently associated with symptomatic peripherally inserted central venous catheter (PICC)-related large vein thrombosis (PRLVT) in neurological intensive care patients.
  
  
  METHODS
  A retrospective cohort study and detailed chart review were performed for 431 consecutive PICCs placed in patients admitted to our neurological intensive care unit between March 2008 and February 2010. Variables theorized to potentially increase the risk of PRLVT were abstracted from the medical record. Each variable was then tested for its independent association with PRLVT.
  
  
  RESULTS
  During the study period, 431 PICCs were placed with an incidence rate for symptomatic thrombosis of 8.4%. In adjusted analysis, catheter placement in a paretic arm (OR, 9.85; 95% CI, 4.42-21.95), surgery longer than 1 h during dwell time of the catheter (OR, 3.26; 95% CI, 1.48-7.17), a history of venous thromboembolism (OR, 6.66; 95% CI, 2.38-18.62), and mannitol use (OR, 3.27; 95% CI 1.27-8.43) were independently associated with the development of thrombosis.
  
  
  CONCLUSIONS
  Alterations in blood flow and consistency, but not vessel injury, appear associated with symptomatic thrombosis following placement of PICCs in neurological intensive care patients. Mannitol use and placement in a paretic arm are potentially modifiable risk factors. Given the high incidence rate of symptomatic thrombosis, future studies should focus on comparing cumulative complications of centrally inserted venous catheters and PICCs in intensive care patients.
authors: Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Room 3552 TC, Ann Arbor, MI 48109-5338, USA.
authors: Thomas J
authors: TJ
authors: Wilson
authors: Devin L
authors: DL
authors: Brown
authors: William J
authors: WJ
authors: Meurer
authors: William R
authors: WR
authors: Stetler
authors: D Andrew
authors: DA
authors: Wilkinson
authors: Jeffrey J
authors: JJ
authors: Fletcher
mesh_terms: D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D056824:Upper Extremity Deep Vein Thrombosis / Q000453:epidemiology*