title: Comparison of catheter-related large vein thrombosis in centrally inserted versus peripherally inserted central venous lines in the neurological intensive care unit.
abstract: OBJECTIVE
  To compare cumulative complication rates of peripherally (PICC) and centrally (CICVC) inserted central venous catheters, including catheter-related large vein thrombosis (CRLVT), central line-associated bloodstream infection (CLABSI), and line insertion-related complications in neurological intensive care patients.
  
  
  METHODS
  Retrospective cohort study and detailed chart review for 431 consecutive PICCs and 141 CICVCs placed in patients under neurological intensive care from March 2008 through February 2010. Cumulative incidence of CRLVT, CLABSI, and line insertion-related complications were compared between PICC and CICVC groups. Risk factors for CRLVT including mannitol therapy during dwell time, previous history of venous thromboembolism, surgery longer than 1h during dwell time, and line placement in a paretic arm were also compared between groups.
  
  
  RESULTS
  During the study period, 431 unique PICCs were placed with cumulative incidence of symptomatic thrombosis of 8.4%, CLABSI 2.8%, and line insertion-related complications 0.0%. During the same period, 141 unique CICVCs were placed with cumulative incidence of symptomatic thrombosis of 1.4%, CLABSI 1.4%, and line insertion-related complications 0.7%. There was a statistically significant difference in CRLVT with no difference in CLABSI or line insertion-related complications.
  
  
  CONCLUSIONS
  In neurological critical care patients, CICVCs appear to have a better risk profile compared to PICCs, with a decreased risk of CRLVT. As use of PICCs in critical care patients increases, a prospective randomized trial comparing PICCs and CICVCs in neurological critical care patients is necessary to assist in choosing the appropriate catheter and to minimize risks of morbidity and mortality associated with central venous access.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109-5338, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Fletcher
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D020767:Intracranial Thrombosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000150:complications; D012306:Risk; D012307:Risk Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology*