title: A Randomized Trial of Central Venous Catheter Type and Thrombosis in Critically Ill Neurologic Patients.
abstract: Observational studies suggest peripherally inserted central venous catheters (PICCs) are associated with a high risk of catheter-related large vein thrombosis (CRLVT) in critically ill neurologic patients. We evaluated the difference in thrombosis risk between PICCs and centrally inserted central venous catheters (CICVCs).
  
  
  
  We conducted a pragmatic, randomized controlled trial of critically ill adult neurologic patients admitted to neurological and trauma critical care units at two level I trauma centers. Patients were randomized to receive either a PICC or CICVC and undergo active surveillance for CRLVT or death within 15 days of catheter placement.
  
  
  
  In total, 39 subjects received a PICC and 41 received a CICVC between February 2012 and July 2015. The trial was stopped after enrollment of 80 subjects due to feasibility affected by slow enrollment and funding. In the primary intention-to-treat analysis, 17 (43.6 %) subjects that received a PICC compared to 9 (22.0 %) that received a CICVC experienced the composite of CRLVT or death, with a risk difference of 21.6 % (95 % CI 1.57-41.71 %). Adjusted common odds ratio of CRLVT/death was significantly higher among subjects randomized to receive a PICC (adjusted OR 3.08; 95 % CI 1.1-8.65). The higher adjusted odds ratio was driven by risk of CRLVT, which was higher in those randomized to PICC compared to CICVC (adjusted OR 4.66; 95 % CI 1.3-16.76) due to increased large vein thrombosis without a reduction in proximal deep venous thrombosis.
  
  
  
  Our trial demonstrates that critically ill neurologic patients who require a central venous catheter have significantly lower odds of ultrasound-diagnosed CRLVT with placement of a CICVC as compared to a PICC.
authors: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552 TC, Ann Arbor, MI, 48109-5338, USA. jflet10121@aol.com.|Department of Neurosurgery, Bronson Methodist Hospital, Kalamazoo, MI, USA. jflet10121@aol.com.
authors: Jeffrey J
authors: JJ
authors: Fletcher
authors: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552 TC, Ann Arbor, MI, 48109-5338, USA.
authors: Thomas J
authors: TJ
authors: Wilson
authors: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552 TC, Ann Arbor, MI, 48109-5338, USA.|Department of Neurology, University of Michigan, Ann Arbor, MI, USA.|Department of Stroke Program, University of Michigan, Ann Arbor, MI, USA.
authors: Venkatakrishna
authors: V
authors: Rajajee
authors: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552 TC, Ann Arbor, MI, 48109-5338, USA.
authors: William R
authors: WR
authors: Stetler
authors: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552 TC, Ann Arbor, MI, 48109-5338, USA.|Department of Neurology, University of Michigan, Ann Arbor, MI, USA.|Department of Stroke Program, University of Michigan, Ann Arbor, MI, USA.
authors: Teresa L
authors: TL
authors: Jacobs
authors: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552 TC, Ann Arbor, MI, 48109-5338, USA.
authors: Kyle M
authors: KM
authors: Sheehan
authors: Department of Neurology, University of Michigan, Ann Arbor, MI, USA.|Department of Stroke Program, University of Michigan, Ann Arbor, MI, USA.
authors: Devin L
authors: DL
authors: Brown
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology; D020246:Venous Thrombosis / Q000209:etiology*
keywords: Central venous catheters; Upper extremity deep venous thrombosis; Vascular access devices; Venous thrombosis