title: Peripherally inserted central catheter thrombosis--reverse tapered versus nontapered catheters: a randomized controlled study.
abstract: OBJECTIVE
  To compare the thrombosis rate, ease of insertion, bleeding rate, and complications of a nontapered peripherally inserted central catheter (PICC) versus a reverse tapered PICC.
  
  
  METHODS
  This was a prospective randomized, controlled trial conducted in single center. All patients 18-90 years old requiring PICC insertion were considered for the study. All patients were followed until PICC removal. Ultrasound examination of the arm was performed at PICC removal or at 28 days. There were 332 patients randomly assigned--164 to the nontapered PICC group and 168 to the reverse tapered PICC group.
  
  
  RESULTS
  The overall thrombosis rate was 71.9%. The thrombosis rate was 70.4% in the nontapered PICC group and 73.4% in the reverse tapered PICC group (P = .58). The symptomatic thrombosis rate was 4.3% in the nontapered PICC group and 3.6% in the reverse tapered PICC group (P = .75). The complete thrombosis rate was 15.6% in the nontapered PICC group compared with 20.8% in the reverse tapered PICC group (P = .44). There was a statistically significantly higher thrombosis rate in patients with cancer (71.9% vs 66.7%, P = .002).
  
  
  CONCLUSIONS
  This study showed a high incidence of thrombosis of peripheral veins used for PICC insertion. The implication of this thrombosis is significant in light of the morbidity and potential mortality associated with this condition. A difference in thrombosis rate between devices could not be detected in this study.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104. Electronic address: itkinmax@gmail.com.
authors.forename: Maxim
authors.initials: M
authors.lastname: Itkin
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondshein
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061807:Catheter Obstruction; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation*; D062905:Central Venous Catheters / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D018615:Ultrasonography, Doppler, Color; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult
keywords: IFU; PICC; instructions for use; peripherally inserted central catheter