Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: A nested case–control study

Chopra, Vineet; Fallouh, Nabil; McGuirk, Helen; Salata, Brian; Healy, Christina; Kabaeva, Zhyldyz; Smith, Shawna N.; Meddings, Jennifer; Flanders, Scott A.

doi:10.1016/j.thromres.2015.02.012

Cited by 40 publications

(28 citation statements)

References 33 publications

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“…31 Conversely, smaller-gauge PICCs occupy less cross-sectional venous area thus allowing greater blood flow around the catheter, substantially reducing this risk. 32 Importantly, some studies have reported savings from the introduction of device-specific policies. For instance, O'Brien and colleagues 9 reported a CA $1.1 million (Canadian dollar) savings over a 2-year period following the institution of a single-lumen PICC policy.…”

Section: Discussionmentioning

confidence: 99%

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

Ratz

Hofer

Flanders

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUND The number of peripherally inserted central catheter (PICC) lumens is associated with thrombotic and infectious complications. Because multilumen PICCs are not necessary in all patients, policies that limit their use may improve safety and cost. OBJECTIVE To design a simulation-based analysis to estimate outcomes and cost associated with a policy that encourages single-lumen PICC use. METHODS Model inputs, including risk of complications and costs associated with single- and multilumen PICCs, were obtained from available literature and a multihospital collaborative quality improvement project. Cost savings and reduction in central line-associated bloodstream infection and deep vein thrombosis events from institution of a single-lumen PICC default policy were reported. RESULTS According to our model, a hospital that places 1,000 PICCs per year (25% of which are single-lumen and 75% multilumen) experiences annual PICC-related maintenance and complication costs of $1,228,598 (95% CI, $1,053,175-$1,430,958). In such facilities, every 5% increase in single-lumen PICC use would prevent 0.5 PICC-related central line-associated bloodstream infections and 0.5 PICC-related deep vein thrombosis events, while saving $23,500. Moving from 25% to 50% single-lumen PICC utilization would result in total savings of $119,283 (95% CI, $74,030-$184,170) per year. Regardless of baseline prevalence, a single-lumen default PICC policy would be associated with approximately 10% cost savings. Findings remained robust in multiway sensitivity analyses. CONCLUSION Hospital policies that limit the number of PICC lumens may enhance patient safety and reduce healthcare costs. Studies measuring intended and unintended consequences of this approach, followed by rapid adoption, appear necessary. Infect Control Hosp Epidemiol 2016;37:811-817.

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Section: Discussionmentioning

confidence: 99%

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

Ratz

Hofer

Flanders

et al. 2016

Infect. Control Hosp. Epidemiol.

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“…Larger PICCs (6 French [F] triple-lumen: 8.8%; .5 F double-lumen 2.9%; .4 F single-lumen: 0.6%) and brachial and cephalic vein insertion sites were associated with a greater risk for symptomatic CRT. 3,22 Catheter tips dwelling above the proximal superior vena cava (SVC) have a sevenfold higher risk of CRT compared with catheter tips located closer to the right atrium. 20,23 An indwell time of .2 weeks also increases the risk of CRT.…”

Section: Risk Factors For Crtmentioning

confidence: 99%

“…3,20,21,27 Treatmentrelated risk factors for CRT include chemotherapy and surgery, whereas therapeutic anticoagulation reduces the risk of thrombosis (relative risk [RR]: 0.47; 95% CI: 0.23-0.99). 3,19,22,25 Prevention of CRT Prevention practices should target patient-, treatment-, and devicerelated risk factors for CRT (Table 1). For example, clinicians should use the smallest caliber catheter possible, ensure proper catheter tip location, and remove CVADs when they are no longer needed.…”

Section: Risk Factors For Crtmentioning

confidence: 99%

How I treat central venous access device–related upper extremity deep vein thrombosis

Rajasekhar

Streiff

2017

Blood

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Central venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.

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“…Highest risk patients are those in an intensive care unit or with malignant disease (Table). 21,22,24 PICC access location and risk is controversial. One study found increased risk of UEDVT with PICCs in the cephalic compared with the basilic vein (23.1% vs 9.6%); however, we identified PICC-related UEDVT twice as often in basilic compared with nonbasilic veins (3.1% vs 1.5%).…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

Management of catheter-associated upper extremity deep venous thrombosis

Crawford

Liem

Moneta

2016

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: A nested case–control study

Cited by 40 publications

References 33 publications

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

How I treat central venous access device–related upper extremity deep vein thrombosis

Management of catheter-associated upper extremity deep venous thrombosis

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