Incidence of Central Vein Stenosis and Occlusion Following Upper Extremity PICC and Port Placement

Abstract

The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters (PICCs) and venous ports. One hundred fifty-four patients who underwent venography of the ipsilateral central veins prior to initial and subsequent venous access device insertion were retrospectively identified. All follow-up venograms were interpreted at the time of catheter placement by one interventional radiologist over a 5-year period and compared to the findings on initial venography. For patients with central vein abnormalities, hospital and home infusion service records and radiology reports were reviewed to determine catheter dwell time and potential alternative etiologies of central vein stenosis or occlusion. The effect of catheter caliber and dwell time on development of central vein abnormalities was evaluated. Venography performed prior to initial catheter placement showed that 150 patients had normal central veins. Three patients had central vein stenosis, and one had central vein occlusion. Subsequent venograms (n = 154) at the time of additional venous access device placement demonstrated 8 patients with occlusions and 10 with stenoses. Three of the 18 patients with abnormal follow-up venograms were found to have potential alternative causes of central vein abnormalities. Excluding these 3 patients and the 4 patients with abnormal initial venograms, a 7% incidence of central vein stenosis or occlusion was found in patients with prior indwelling catheters and normal initial venograms. Catheter caliber showed no effect on the subsequent development of central vein abnormalities. Patients who developed new or worsened central vein stenosis or occlusion had significantly (p = 0.03) longer catheter dwell times than patients without central vein abnormalities. New central vein stenosis or occlusion occurred in 7% of patients following upper arm placement of venous access devices. Patients with longer catheter dwell time were more likely to develop central vein abnormalities. In order to preserve vascular access for dialysis fistulae and grafts and adhere to Dialysis Outcomes Quality Initiative guidelines, alternative venous access sites should be considered for patients with chronic renal insufficiency and end-stage renal disease.

The Risk Factors and Clinical Outcomes of Upper Extremity Deep Vein Thrombosis

“…8 Unlike the relatively high rate of venous thrombosis from PICCs in the study by Allen et al, lower rates of thrombosis associated with PICC were reported in other studies (2.5% to 7%). 7,[16][17][18] Recently Evans et al conducted a prospective observational study of PICC insertions at an academic medical center with a level I trauma center over a 1-year period and reported that 3.0% of symptomatic patients with PICC lines developed UEDVT, and the most common risk factors were prior DVT and surgery lasting > 1 hour. 18 They emphasized that the size of CVCs was significantly associated with increasing risk of PICC-associated DVT.…”

Heamodialysis Patients; Central Vein Stenosis Following Temporary Double Lumen Catherization in Internal Jugular and Subclavian Veins

“…Unfortunately, all the available treatment options have poor longterm patency, requiring repetitive intervention. 6,7,8 and sometimes due to stenosis patient has to undergo special and costly imaging to undergo catherization at atypical sites. 9 Few studies conducted on various type of populations has been conducted and data on the prevalence of central venous stenosis following catheterization in Pakistan.…”

Peripherally Inserted Central Catheters and Hemodialysis Outcomes

“…PICC placement enables blood sampling and continuous vascular access without frequent venipunctures or direct cannulation of central veins, and these conveniences contribute to their expanding popularity (22,23). Because PICC use has increased, potential concerns about bloodstream infections, thromboses, and stenoses of central and peripheral veins have emerged (11)(12)(13)24,25).…”

“…Their use shortens the length of stay in hospitals and nursing facilities, and utilization has increased rapidly over the past 15 years (10,11). However, PICC use also is associated with stenosis, thrombosis, and obliteration of the central and peripheral veins in which they dwell (12,13), and these complications may have important long-term consequences for patients who subsequently require HD vascular access. Patients with CKD often have complex preexisting comorbid conditions that may result in PICC exposure, potentially increasing their risk for loss of veins (14).…”