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Original Research: DEEP VEIN THROMBOSIS |

Risk of Symptomatic DVT Associated With Peripherally Inserted Central Catheters

R. Scott Evans, PhD; Jamie H. Sharp, RN, CNSN; Lorraine H. Linford, RN, BS, CNSN; James F. Lloyd, BS; Jacob S. Tripp, PhD; Jason P. Jones, PhD; Scott C. Woller, MD; Scott M. Stevens, MD; C. Gregory Elliott, MD, FCCP; Lindell K. Weaver, MD, FCCP
Author and Funding Information

From Medical Informatics (Drs Evans, Jones, and Tripp and Mr Lloyd), Intermountain Healthcare; Biomedical Informatics (Drs Evans and Jones), University of Utah School of Medicine; the Nutrition Support Service/PICC Team (Mss Sharp and Linford), Medical Center; the Department of Medicine (Drs Woller, Stevens, and Elliott), Intermountain Medical Center; Hyperbaric Medicine (Dr Weaver), Intermountain Healthcare, and the Department of Medicine (Drs Woller, Stevens, Elliott, and Weaver), University of Utah School of Medicine, Salt Lake City, UT.

Correspondence to: R. Scott Evans, PhD, Department of Medical Informatics, LDS Hospital, 8th Ave & C St, Salt Lake City, UT 84143; e-mail: rscott.evans@imail.org


Funding/Support: This work was performed at Intermountain Medical Center and supported by Intermountain Healthcare

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(4):803-810. doi:10.1378/chest.10-0154
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Background:  Previous studies undertaken to identify risk factors for peripherally inserted central catheter (PICC)-associated DVT have yielded conflicting results. PICC insertion teams and other health-care providers need to understand the risk factors so that they can develop methods to prevent DVT.

Methods:  A 1-year prospective observational study of PICC insertions was conducted at a 456-bed, level I trauma center and tertiary referral hospital affiliated with a medical school. All patients with one or more PICC insertions were included to identify the incidence and risk factors for symptomatic DVT associated with catheters inserted by a facility-certified PICC team using a consistent and replicated approach for vein selection and insertion.

Results:  A total of 2,014 PICCs were inserted during 1,879 distinct hospitalizations in 1,728 distinct patients for a total of 15,115 days of PICC placement. Most PICCs were placed in the right arm (76.9%) and basilic vein (74%) and were double-lumen 5F (75.3%). Of the 2,014 PICC insertions, 60 (3.0%) in 57 distinct patients developed DVT in the cannulated or adjacent veins. The best-performing predictive model for DVT (area under the curve, 0.83) was prior DVT (odds ratio [OR], 9.92; P < .001), use of double-lumen 5F (OR, 7.54; P < .05) or triple-lumen 6F (OR, 19.50; P < .01) PICCs, and prior surgery duration of > 1 h (OR, 1.66; P = .10).

Conclusions:  Prior DVT and surgery lasting > 1 h identify patients at increased risk for PICC-associated DVT. More importantly, increasing catheter size also is significantly associated with increased risk. Rates of PICC-associated DVT may be reduced by improved selection of patients and catheter size.

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