The use of PICCs in Intensive Care Units (ICU) is increasing significantly. UEDVT is a known complication associated with placement of catheters. Knowledge about PICC associated UEDVT is primarily limited to retrospective studies and the incidence of PICC associated thrombosis varies from 0.3 to 60%. The purpose of this study is to prospectively evaluate the incidence of PICC associated thrombosis in patients admitted to a medical ICU.
We are conducting a RCT on prevention of PICC associated UEDVT using prophylactic low-molecular weight heparin (LMWH) versus unfractionated heparin. All ICU patients having a PICC placed were evaluated. Exclusion criteria for enrollment included therapeutic anticoagulation, contraindications to prophylactic anticoagulation, thrombocytopenia and hemodialysis. If the PICC was in superior vena cava, as determined by a radiograph, the patients were enrolled. All patients received prophylactic anticoagulation with unfractionated heparin (5000 units three times a day, subcutaneously) or LMWH (30 to 40 mg per day, subcutaneously). Duplex ultrasonography was performed on the upper extremity prior to removal of the PICC or 10 days after insertion, whichever was earlier.
A total of 31 patients with PICC placed in the ICU completed the study to date. Duplex ultrasonography was positive for a DVT in 20 patients. 8 of them were occlusive and 12, non-occlusive. None of the patients were symptomatic.
The incidence of UEDVT associated with PICC in the ICU may be higher than previously reported, despite prophylactic anticoagulation. The majority of patients are asymptomatic.
Asymptomatic UEDVT associated with PICCs are common. The clinical course is unclear, including the incidence of PE associated with these DVT.
Table: Results.Day # of the Ultrasonography following the PICC placementNumber of patientsOcclusive DVTNon-occlusive DVTNo DVT1NoneNANANA2311132101432105401367142730218302192110104202Total318 (26 %)12 (39%)11 (35%)Total DVT: 20 (65%)
Srinivas Chakravarthy, Grant monies (from sources other than industry) This study was supported by an award from The CHEST Foundation of the American College of Chest Physicians.