Risk of Deep Venous Thrombosis Associated with Peripherally Inserted Central Catheter: A Retrospective Cohort Study of 11.588 Catheters in Brazil

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 May 6

PMID 38709807

Authors

Telma Christina do Campo Silva

Luciene Muniz Braga

Jose Mauro Vieira Junior

Affiliations

Soon will be listed here.

Abstract

Introduction: Deep Venous Thrombosis (DVT) due to Peripherally Inserted Central Catheter (PICC) is one of the most threatening complications after device insertion.

Objective: To assess the rate of PICC-associated DVT and analyze the risk factors associated with this event in cancer and critically ill patients.

Methods: We conducted a descriptive, retrospective cohort study with 11,588 PICCs from December 2014 to December 2019. Patients ≥ 18 years receiving a PICC were included. Pre-and post-puncture variables were collected and a logistic regression was used to identify the independent factors associated with the risk of DVT.

Results: The DVT prevalence was 1.8% (n = 213). The median length of PICC use was 15.3 days. The median age was 75 years (18; 107) and 52% were men, 53.5% were critically ill and 29.1% oncological patients. The most common indications for PICC's were intravenous antibiotics (79.1%). Notably, 91.5% of PICC showed a catheter-to-vein ratio of no more than 33%. The tip location method with intracavitary electrocardiogram was used in 43%. Most catheters (67.9%) were electively removed at the end of intravenous therapy. After adjusting for cancer profile ou chemotherapy, regression anaysis revealed that age (OR 1.011; 95% CI 1.002-1.020), previous DVT (OR 1.96; 95% CI 1.12-3.44) and obstruction of the device (OR 1.60; 95% CI 1.05-2.42) were independent factors associated with PICC-associated DVT, whereas the use of an anticoagulant regimen was a protective variable (OR 0.73; 95% CI 0.54-0.99).

Conclusion: PICC is a safe and suitable intravenous device for medium and long-term therapy, with low rates of DVT even in a cohort of critically ill and cancer patients.

References

Pittiruti M, Bilancia A, Ortiz Miluy G, DArrigo S . A comparison between two radiological criteria for verifying tip location of central venous catheters. J Vasc Access. 2022; 25(2):551-556. DOI: 10.1177/11297298221126818. View

Spencer T, Mahoney K . Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio. J Thromb Thrombolysis. 2017; 44(4):427-434. DOI: 10.1007/s11239-017-1569-y. View

Obeid J, McGraw C, Minor B, Conde J, Pawluk R, Lin M . Procurement of shared data instruments for Research Electronic Data Capture (REDCap). J Biomed Inform. 2012; 46(2):259-65. PMC: 3600393. DOI: 10.1016/j.jbi.2012.10.006. View

Govindan S, Snyder A, Flanders S, Chopra V . Peripherally Inserted Central Catheters in the ICU: A Retrospective Study of Adult Medical Patients in 52 Hospitals. Crit Care Med. 2018; 46(12):e1136-e1144. PMC: 6317857. DOI: 10.1097/CCM.0000000000003423. View

Di Santo M, Takemoto D, Nascimento R, Nascimento A, Siqueira E, Duarte C . . J Vasc Bras. 2018; 16(2):104-112. PMC: 5915858. DOI: 10.1590/1677-5449.011516. View

Smith S, Moureau N, Vaughn V, Boldenow T, Kaatz S, Grant P . Patterns and Predictors of Peripherally Inserted Central Catheter Occlusion: The 3P-O Study. J Vasc Interv Radiol. 2017; 28(5):749-756.e2. DOI: 10.1016/j.jvir.2017.02.005. View

Sperry B, Roskos M, Oskoui R . The effect of laterality on venous thromboembolism formation after peripherally inserted central catheter placement. J Vasc Access. 2011; 13(1):91-5. DOI: 10.5301/jva.5000014. View

Pinelli F, Balsorano P, Mura B, Pittiruti M . Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later. J Vasc Access. 2020; 22(4):501-508. DOI: 10.1177/1129729820947594. View

Moureau N, Chopra V . Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations. Br J Nurs. 2016; 25(8):S15-24. DOI: 10.12968/bjon.2016.25.8.S15. View

10.

Chopra V, Anand S, Krein S, Chenoweth C, Saint S . Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med. 2012; 125(8):733-41. DOI: 10.1016/j.amjmed.2012.04.010. View

11.

Chopra V, Anand S, Hickner A, Buist M, Rogers M, Saint S . Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet. 2013; 382(9889):311-25. DOI: 10.1016/S0140-6736(13)60592-9. View

12.

Meyer B, Berndt D, Biscossi M, Eld M, Gillette-Kent G, Malone A . Vascular Access Device Care and Management: A Comprehensive Organizational Approach. J Infus Nurs. 2020; 43(5):246-254. DOI: 10.1097/NAN.0000000000000385. View

13.

Kusminsky R . Complications of central venous catheterization. J Am Coll Surg. 2007; 204(4):681-96. DOI: 10.1016/j.jamcollsurg.2007.01.039. View

14.

Kamata Y, Mizuno Y, Okamoto K, Okamoto S, Ito Y, Nishigata A . Peripherally inserted central catheters can be an alternative to tunneled central venous catheters in chemotherapy for hematological and oncological pediatric patients. Pediatr Surg Int. 2023; 39(1):264. PMC: 10482767. DOI: 10.1007/s00383-023-05545-4. View

15.

Brescia F, Pittiruti M, Spencer T, Dawson R . The SIP protocol update: Eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access. 2022; 25(1):5-13. PMC: 10845830. DOI: 10.1177/11297298221099838. View

16.

Honore P, Redant S, Preseau T, Moorthamers S, Kaefer K, Barreto Gutierrez L . Use of peripherally inserted central catheters in ICU patients: We need to put in balance the important risks versus the potential advantages!. J Crit Care. 2021; 66:184-185. DOI: 10.1016/j.jcrc.2021.06.023. View

17.

Paquet F, Boucher L, Valenti D, Lindsay R . Impact of arm selection on the incidence of PICC complications: results of a randomized controlled trial. J Vasc Access. 2017; 18(5):408-414. DOI: 10.5301/jva.5000738. View

18.

Wall C, Moore J, Thachil J . Catheter-related thrombosis: A practical approach. J Intensive Care Soc. 2017; 17(2):160-167. PMC: 5606399. DOI: 10.1177/1751143715618683. View

19.

Todd J . Peripherally inserted central catheters and their use in i.v. therapy. Br J Nurs. 1999; 8(3):140-2, 144, 146-8. DOI: 10.12968/bjon.1999.8.3.6699. View

20.

Rabelo-Silva E, Lourenco S, Maestri R, Candido da Luz C, Carlos Pupin V, Bauer Cechinel R . Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters. BMJ Qual Saf. 2022; 31(9):652-661. PMC: 9411873. DOI: 10.1136/bmjqs-2021-013869. View