Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: A nested case-control study.
BACKGROUND
Peripherally inserted central catheters (PICCs) are associated with upper extremity-deep vein thrombosis (DVT). However, patterns, risk factors and treatment associated with this event remain poorly defined.


OBJECTIVE
To determine patterns, risk factors and treatment related to PICC-DVT in hospitalized patients.


METHODS
Between 2012-2013, consecutive cases of ultrasound-confirmed, symptomatic PICC-DVT were identified. For each case, at least two contemporaneous controls were identified and matched by age and gender. Patient- and device-specific data were obtained through electronic-medical records. Using variables selected a priori, multivariable logistic regression models were fit to the outcome of PICC-DVT, comparing cases to controls.


RESULTS
909 adult hospitalized patients (268 cases, 641 controls) were included in the study. Indications for PICC placement included long-term intravenous antibiotic therapy (n=447; 49.1%), in-hospital venous access for blood draws or infusion of medications (n=342; 44.2%), and total parenteral nutrition (n=120; 6.7%). Patients with PICC-DVT were more likely to have a history of venous thromboembolism (OR 1.70, 95% CI=1.02-2.82) or have undergone surgery while the PICC was in situ (OR 2.17, 95%CI=1.17-4.01 for surgeries longer than two hours). Treatment for PICC-DVT varied and included heparin bridging, low molecular weight heparin only and device removal only; the average duration of treatment also varied across these groups. Compared to 4-Fr PICCs, 5- and 6-Fr PICCs were associated with greater risk of DVT (OR 2.74, 95%CI=0.75-10.09 and OR 7.40 95%CI=1.94-28.16, respectively). Patients who received both aspirin and statins were less likely to develop PICC-DVT than those that received neither treatment (OR 0.31, 95%CI=0.16-0.61). Receipt of pharmacological DVT prophylaxis during hospitalization showed a non-significant trend towards reduction in risk of PICC-DVT (OR=0.72, 95%CI=0.48-1.08).


CONCLUSIONS
Several factors appear associated with PICC-DVT. While some of these characteristics may be non-modifiable, future studies that target potentially modifiable variables to prevent this adverse outcome would be welcomed.
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA; The Patient Safety Enhancement Program, USA; The Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. Electronic address: vineet@umich.edu.
Vineet
V
Chopra
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Nabil
N
Fallouh
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA; The Patient Safety Enhancement Program, USA.
Helen
H
McGuirk
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Brian
B
Salata
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Christina
C
Healy
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Zhyldyz
Z
Kabaeva
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA; The Patient Safety Enhancement Program, USA.
Shawna
S
Smith
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA; The Patient Safety Enhancement Program, USA.
Jennifer
J
Meddings
The Department of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Scott A
SA
Flanders
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology*; D055815:Young Adult
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin