The Association Between PICC Use and Venous Thromboembolism in Upper and Lower Extremities.
BACKGROUND
Peripherally inserted central catheters are associated with upper-extremity deep vein thrombosis. Whether they also are associated with lower-extremity deep vein thrombosis or pulmonary embolism is unknown. We examined the risk of venous thromboembolism in deep veins of the arm, leg, and chest after peripherally inserted central catheter placement.


METHODS
We conducted a multicenter, retrospective cohort study of 76,242 hospitalized medical patients from 48 Michigan hospitals. Peripherally inserted central catheter presence, comorbidities, venous thrombosis risk factors, and thrombotic events within 90 days from hospital admission were ascertained by phone and record review. Cox proportional hazards models were fit to examine the association between peripherally inserted central catheter placement and 90-day hazard of upper- and lower-extremity deep vein thrombosis or pulmonary embolism, adjusting for patient-level characteristics and natural clustering within hospitals.


RESULTS
A total of 3790 patients received a peripherally inserted central catheter during hospitalization. From hospital admission to 90 days, 876 thromboembolic events (208 upper-extremity deep vein thromboses, 372 lower-extremity deep vein thromboses, and 296 pulmonary emboli) were identified. After risk adjustment, peripherally inserted central catheter use was independently associated with all-cause venous thromboembolism (hazard ratio [HR], 3.16; 95% confidence interval [CI], 2.59-3.85), upper-extremity deep vein thrombosis (HR, 10.49; 95% CI, 7.79-14.11), and lower-extremity deep vein thrombosis (HR, 1.48; 95% CI, 1.02-2.15). Peripherally inserted central catheter use was not associated with pulmonary embolism (HR, 1.34; 95% CI, 0.86-2.06). Results were robust to sensitivity analyses incorporating receipt of pharmacologic prophylaxis during hospitalization.


CONCLUSIONS
Peripherally inserted central catheter use is associated with upper- and lower-extremity deep vein thrombosis. Weighing the thrombotic risks conferred by peripherally inserted central catheters against clinical benefits seems necessary.
The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Mich; Department of Internal Medicine, Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, Mich; VA Ann Arbor Health Care System, Ann Arbor, Mich.
M Todd
MT
Greene
The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Mich; Department of Internal Medicine, Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, Mich.
Scott A
SA
Flanders
Intermountain Medical Center, Murray, Utah; University of Utah School of Medicine, Salt Lake City, Utah.
Scott C
SC
Woller
The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Mich; Department of Internal Medicine, Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, Mich; VA Ann Arbor Health Care System, Ann Arbor, Mich.
Steven J
SJ
Bernstein
The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Mich; Department of Internal Medicine, Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, Mich; VA Ann Arbor Health Care System, Ann Arbor, Mich. Electronic address: vineetc@umich.edu.
Vineet
V
Chopra
D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology*; D020246:Venous Thrombosis / Q000209:etiology*
Deep vein thrombosis; Peripherally inserted central catheter; Venous thromboembolism