Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters

Authors

  • Bob L. Lobo Pharm.D.,

    Corresponding author
    1. College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
    2. Department of Pharmacy, Vanderbilt University Hospital, Nashville, Tennessee
    • Department of Pharmacy, 1211 Medical Center, B101, Nashville, TN 37232
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    • Telephone: 615-343-9840; Fax: 615-343-7280

  • Georgeta Vaidean MD, MPH, PhD,

    1. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Joyce Broyles Pharm.D.,

    1. College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
    2. Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee
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  • Anne B. Reaves Pharm.D,

    1. College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
    2. Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee
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  • Ronald I. Shorr MD, MS

    1. Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
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  • All data were collected at Methodist University Hospital, Memphis, TN. Author contributions are as follows: B.L.L. and G.V. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; study concept and design: B.L.L., G.V., R.S.; acquisition of data: B.L.L., J.B.; analysis and interpretation of data: G.V., B.L.L., J.B.; drafting of the manuscript: B.L.L., G.V., A.B.R.; statistical analysis: G.V.; obtained funding: B.L.L.; administrative, technical, or material support: B.L.L., J.B.; study supervision: B.L.L., G.V. Methodist Healthcare Foundation funded this study for data collection and management. Methodist Healthcare Foundation was not involved in the management, analysis, or interpretation of data or the preparation of the manuscript. Methodist Healthcare Foundation reviewed the manuscript prior to submission for publication.

  • Disclosure: Nothing to report.

Abstract

BACKGROUND:

Peripherally inserted central catheters (PICC) are increasingly used in hospitalized patients. The benefit can be offset by complications such as upper extremity deep vein thrombosis (UEDVT).

METHODS:

Retrospective study of patients who received a PICC while hospitalized at the Methodist University Hospital (MUH) in Memphis, TN. All adult consecutive patients who had PICCs inserted during the study period and who did not have a UEDVT at the time of PICC insertion were included in the study. A UEDVT was defined as a symptomatic event in the ipsilateral extremity, leading to the performance of duplex ultrasonography, which confirmed the diagnosis of UEDVT. Pulmonary embolism (PE) was defined as a symptomatic event prompting the performance of ventilation-perfusion lung scan or spiral computed tomography (CT).

RESULTS:

Among 777 patients, 38 patients experienced 1 or more venous thromboembolisms (VTEs), yielding an incidence of 4.89%. A total of 7444 PICC-days were recorded for 777 patients. This yields a rate of 5.10 VTEs/1000 PICC-days. Compared to patients whose PICC was inserted in the SVC, patients whose PICC was in another location had an increased risk (odds ratio = 2.61 [95% CI = 1.28-5.35]) of VTE. PICC related VTE was significantly more common among patients with a past history of VTE (odds ratio = 10.83 [95% CI = 4.89-23.95]).

CONCLUSIONS:

About 5% of patients undergoing PICC placement in acute care hospitals will develop thromboembolic complications. Thromboembolic complications were especially common among persons with a past history of VTE. Catheter tip location at the time of insertion may be an important modifiable risk factor. Journal of Hospital Medicine 2009;4:417–422. © 2009 Society of Hospital Medicine.

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