title: Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis.
abstract: BACKGROUND
  Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs.
  
  
  METHODS
  We searched several databases, including Medline, Embase, Biosis, Cochrane Central Register of Controlled Trials, Conference Papers Index, and Scopus. Additional studies were identified through hand searches of bibliographies and internet searches, and we contacted study authors to obtain unpublished data. All human studies published in full text, abstract, or poster form were eligible for inclusion. All studies were of adult patients aged at least 18 years who underwent insertion of a PICC. Studies were assessed with the Newcastle-Ottawa risk of bias scale. In studies without a comparison group, the pooled frequency of venous thromboembolism was calculated for patients receiving PICCs. In studies comparing PICCs with other CVCs, summary odds ratios (ORs) were calculated with a random effects meta-analysis.
  
  
  RESULTS
  Of the 533 citations identified, 64 studies (12 with a comparison group and 52 without) including 29 503 patients met the eligibility criteria. In the non-comparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill (13·91%, 95% CI 7·68-20·14) and those with cancer (6·67%, 4·69-8·64). Our meta-analysis of 11 studies comparing the risk of deep vein thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of deep vein thrombosis (OR 2·55, 1·54-4·23, p<0·0001) but not pulmonary embolism (no events). With the baseline PICC-related deep vein thrombosis rate of 2·7% and pooled OR of 2·55, the number needed to harm relative to CVCs was 26 (95% CI 13-71).
  
  
  CONCLUSIONS
  PICCs are associated with a higher risk of deep vein thrombosis than are CVCs, especially in patients who are critically ill or those with a malignancy. The decision to insert PICCs should be guided by weighing of the risk of thrombosis against the benefit provided by these devices.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA. vineetc@umich.edu
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
authors.forename: Sarah
authors.initials: S
authors.lastname: Anand
authors.forename: Andy
authors.initials: A
authors.lastname: Hickner
authors.forename: Michael
authors.initials: M
authors.lastname: Buist
authors.forename: Mary Am
authors.initials: MA
authors.lastname: Rogers
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology*