title: Peripherally Inserted Central Catheter-associated Deep Vein Thrombosis: A Narrative Review.
abstract: BACKGROUND
  Although common, little is known about factors associated with peripherally inserted central catheter-related deep vein thrombosis (PICC-DVT). To better guide clinicians, we performed a comprehensive literature review to summarize best practices for this condition.
  
  
  METHODS
  A systematic search of the literature for studies reporting epidemiology, diagnosis, treatment, and prevention of PICC-DVT was conducted. Algorithms for diagnosis and management were compiled using available evidence.
  
  
  RESULTS
  The incidence of PICC-DVT varied between 2% and 75% according to study population, testing modality and threshold for diagnosis. Studies evaluating the diagnostic utility of clinical symptoms suggested that these were neither sensitive nor specific for PICC-DVT; conversely, ultrasonography had excellent sensitivity and specificity and is recommended as the initial diagnostic test. Although more specific, contrast venography should be reserved for cases with high clinical probability and negative ultrasound findings. Centrally positioned, otherwise functional and clinically necessary PICCs need not be removed despite concomitant DVT. Anticoagulation with low-molecular-weight heparin or warfarin for at least 3 months represents the mainstay of treatment. The role of pharmacologic prophylaxis and screening for PICC-DVT in the absence of clinical symptoms is unclear at this time.
  
  
  CONCLUSIONS
  PICC-DVT is common, costly and morbid. Available evidence provides guidance for diagnosis, treatment and prevention of this condition.
authors.affiliation: Department of General Medicine, University of Michigan Health System, Ann Arbor.
authors.forename: Nabil
authors.initials: N
authors.lastname: Fallouh
authors.affiliation: Department of General Medicine, University of Michigan Health System, Ann Arbor; Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and the Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Mich.
authors.forename: Helen M
authors.initials: HM
authors.lastname: McGuirk
authors.affiliation: Department of General Medicine, University of Michigan Health System, Ann Arbor.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
authors.affiliation: Department of General Medicine, University of Michigan Health System, Ann Arbor; Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and the Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Mich. Electronic address: vineetc@umich.edu.
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D062905:Central Venous Catheters / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D033262:Narration; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: DVT; Deep vein thrombosis; Diagnosis; PICC; Peripherally inserted central catheter; Prevention; Thrombosis; Treatment