title: Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors.
abstract: BACKGROUND
  Despite growing use, peripherally inserted central catheters (PICCs) are associated with risk of deep vein thrombosis (DVT). We designed a study to determine patient, provider and device factors associated with this outcome.
  
  
  METHODS
  This was a retrospective cohort study of adults who underwent PICC placement between 1 June 2009 to 30 June 2012. Symptomatic PICC-associated DVT was confirmed by ultrasound. Because PICCs are also recognized risk factors for lower-extremity DVT, lower-extremity DVT occurring while the PICC was in situ was included. Multivariable logistic and Cox-proportional hazards regression models were fit to examine the association between covariates specified a priori and PICC-DVT. Odds ratios (ORs) and hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were generated.
  
  
  RESULTS
  Of 966 unique PICC placements, 33 patients developed symptomatic PICC-associated DVT and 9 developed lower-extremity DVT, accounting for 42 thrombotic events. On bivariate analysis, recent diagnosis of cancer, interventional radiology placement, chemotherapy administration, number of lumens and PICC-gauge were associated with PICC-DVT. Following multivariable adjustment, recent cancer diagnosis (OR 1.95 [95% CI 1.01-3.76]) and PICC gauge (HR 2.21 [95%CI 1.04-4.70] and HR 3.56 [95%CI 1.31-9.66] for 5-Fr and 6-Fr PICCs, respectively) remained associated with thrombosis.
  
  
  CONCLUSIONS
  Recent diagnosis of cancer and PICC gauge are associated with PICC-DVT. These findings have important clinical ramifications and suggest that placement of large gauge PICCs or PICCs in patients with cancer may provoke thrombosis. Improved policies and procedural oversights in these areas appear necessary to prevent PICC-DVT.
authors.affiliation: The Patient Safety Enhancement Program, The Center for Clinical Management Research, Ann Arbor, MI, USA; The VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; The University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: V
authors.initials: V
authors.lastname: Chopra
authors.forename: D
authors.initials: D
authors.lastname: Ratz
authors.forename: L
authors.initials: L
authors.lastname: Kuhn
authors.forename: T
authors.initials: T
authors.lastname: Lopus
authors.forename: A
authors.initials: A
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Krein
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D014728:Veterans
keywords: central venous catheter thrombosis; central venous catheters; deep vein thrombosis; peripheral venous catheterization; upper extremity deep vein thrombosis; venous thromboembolism