The use of peripherally inserted central catheters (PICCs) has increased significantly over the past several years. Upper extremity deep venous thrombosis (UEDVT) is a known complication of PICCs, with a reported symptomatic incidence of 3-5% in recent large reviews; the incidence of PICC associated UEDVT has not been reported specifically in critically ill patients. Our goal was to determine the incidence of symptomatic PICC associated UEDVT in an intensive care unit (ICU).
Retrospective database and chart review of all patients admitted to a 12-bed tertiary university hospital medical intensive care unit (MICU) during 2002. All patients having PICCs placed while in the MICU were included. The database and electronic chart were reviewed to determine which patients with PICCs had a subsequent diagnosis of UEDVT in the ipsilateral extremity. Diagnosis of UEDVT required a positive duplex ultrasound or venogram of the affected extremity. Such studies were ordered at the discretion of the treating physician based upon patient signs/symptoms. The method of DVT prophylaxis in all PICC patients was also obtained from the database.
Sixteen symptomatic UEDVTs developed in the 113 patients with PICCs (incidence 14.2%). PICC lines were present for a significantly greater number of days in those with versus those without UEDVTs (19.5±3.8 vs. 10.8±1.1; p= .0005). There was no difference between groups in admitting acute physiology and chronic health evaluation (APACHE) II score, insertion of central venous catheters, or use of heparin or pneumatic compression devices for lower extremity DVT prophylaxis.CONCLUSIONS: Compared to other patient populations in the literature, the incidence of symptomatic PICC associated UEDVT appears to be considerably higher in critically ill patients. The duration of catheter use is significantly associated with the development of symptomatic UEDVTs.
A high index of clinical suspicion for UEDVT should be maintained in ICU patients with PICCs, particularly in patients with catheters in place for prolonged durations.
J.A. Rettmann, None.