SESSION TITLE: Venous Thromboembolism Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: PICC lines are the better alternative for advanced access when peripheral lines are not feasible. Seeking more on risk factors, treatment, complications of UEDVT associated with PICC lines for prevention and management of this rising problem is imperative.
METHODS: A retrospective chart review of 426 patients, who had undergone PICC placement from January 2013 to June 2013. Study group included all patients with PICC line associated UEDVT. Control group included first 25 patients with PICC lines but no UEDVT. Patients on active anticoagulation and comfort care were excluded. Charts reviewed for incidence of positive DVT in ultra-sound scans of upper extremities, treatment offered for DVT, complications of treatment and risk factors for DVT.
RESULTS: The cohort consisted of 25 DVT positive patients and 25 DVT negative patients. Mean age of a DVT positive patient was 70 and negative patient was 60 ( P=0.03). The commonest site for UEDVT was the brachial vein. The Superior Vena Cava is the most frequent site for final tip placement. There was no relationship between the 3 sites of tip placement and occurrence of DVT. The duration of the PICC line was not associated with UEDVT. Both inpatient and outpatients had similar risk for UEDVT. Blocked catheters and tissue Plasminogen Activator (tPA) use was not associated with occurrence of UEDVT. Usual risk factors for lower extremity DVT like cancer, not being on chemical DVT prophylaxis did not have any influence on PICC line associated UEDVT. The type of infusate did not have any bearing of the occurrence of PICC associated UEDVT, although vancomycin infusion showed a trend towards significance. PICC access >4 times a day vs once a day was significantly associated with UEDVT. Length of stay was identified as significantly associated with PICC associated UEDVT. The incidence of PE was 8%. The median PICC to DVT time was 8 days. The most popular method of treatment was PICC salvage.
CONCLUSIONS: Incidence of UEDVT associated with PICC lines in a 400 bed hospital in upstate NY from January 2013 to June 2013 is 5%. This is comparable with current pulished literature. The other risk factors identified are increased number of times the PICC line is accessed, advanced age, high comorbidity index and increased length of stay.
CLINICAL IMPLICATIONS: Usual risk factors for lower extremity DVT are not significant in PICC line associated UEDVT. Early discontinuation of PICC lines may prevent UEDVT.
DISCLOSURE: The following authors have nothing to disclose: Avanthika Wickramarathne, Gary Wahl
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