PURPOSE: Peripherally inserted central catheters (PICCs) are venous access devices commonly used for patients in need of medication or fluid known to be caustic to peripheral venous intimal lining and for patients who require a longer duration of continuous access than that provided by standard peripheral access. Our study addresses whether or not PICCs are associated with an increased risk of upper extremity deep venous thrombosis (DVT). To date, there are no conclusive studies regarding this topic.
METHODS: We performed a retrospective analysis of all hospitalized adult patients in a specialized headache treatment unit who underwent PICC placement at our hospital from January 27, 2004, to March 2, 2005 (n=468). We evaluated multiple risk factors to determine if they increased the risk of DVT in patients with PICCs. Of note, several patients received clopidogrel while the catheter was in place, data which is also analyzed in our study. Patients underwent duplex ultrasonography to diagnose upper extremity DVT only if they displayed clinical signs or symptoms including upper extremity pain, edema, erythema, tenderness, and/or unexplained fever.
RESULTS: The overall incidence of PICC-associated DVT was 0.80% (n=2), not statistically significant when compared to the average risk of upper extremity DVT in adult hospitalized patients. PICCs conferred no additional risk of DVT over patients’ baseline risk factors. Clopidogrel offered no prophylactic advantage against DVT.
CONCLUSION: Patients with PICCs are not at increased risk for upper extremity DVT when compared to other hospitalized patients. In patients with single or multiple risk factors for DVT, PICCs do not create an added risk for DVT. Clopidogrel does not clearly offer an advantage in DVT prophylaxis.
CLINICAL IMPLICATIONS: Hospitalized patients with PICCs should receive standard DVT prophylaxis only, in accordance with the presence or absence of other risk factors for DVT, as PICCs do not create additional risk in and of themselves. Clopidogrel should not be used for DVT prophylaxis.
DISCLOSURE: Todd Worley, No Financial Disclosure Information; No Product/Research Disclosure Information