The Michigan Risk Score to predict peripherally inserted central catheter‐associated thrombosis

Abstract

Background Peripherally inserted central catheters (PICCs) are associated with upper extremity deep vein thrombosis (DVT). We developed a score to predict risk of PICC-related thrombosis. Methods Using data from the Michigan Hospital Medicine Safety Consortium, image-confirmed upper-extremity DVT cases were identified. A logistic, mixed-effects model with hospital-specific random intercepts was used to identify factors associated with PICC-DVT. Points were assigned to each predictor, stratifying patients into four classes of risk. Internal validation was performed by bootstrapping with assessment of calibration and discrimination of the model. Results Of 23 010 patients who received PICCs, 475 (2.1%) developed symptomatic PICC-DVT. Risk factors associated with PICC-DVT included: history of DVT; multi-lumen PICC; active cancer; presence of another CVC when the PICC was placed; and white blood cell count greater than 12 000. Four risk classes were created based on thrombosis risk. Thrombosis rates were 0.9% for class I, 1.6% for class II, 2.7% for class III and 4.7% for class IV, with marginal predicted probabilities of 0.9% (0.7, 1.2), 1.5% (1.2, 1.9), 2.6% (2.2, 3.0) and 4.5% (3.7, 5.4) for classes I, II, III, and IV, respectively. The risk classification rule was strongly associated with PICC-DVT, with odds ratios of 1.68 (95% CI, 1.19, 2.37), 2.90 (95% CI, 2.09, 4.01) and 5.20 (95% CI, 3.65, 7.42) for risk classes II, III and IV vs. risk class I, respectively. Conclusion The Michigan PICC-DVT Risk Score offers a novel way to estimate risk of DVT associated with PICCs and can help inform appropriateness of PICC insertion.

A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill

“…Thrombosis risk is particularly pronounced for PICCs as they often migrate from the cavoatrial junction [104] and are inserted into smaller veins.…”

Vascular access in cancer patients – clinical implications

“…When assessing the situation as a whole, more attention should be paid to selecting the best vascular access device alternative for each individual, possibly guided by CR-DVT risk-assessment tools. 152 In light of the available evidence regarding safety, patient preference, and health economy more effort should be made in making PORTs available for patients with cancer.…”

Developing, Implementing, and Evaluating a Multimedia Patient Decision Aid Program to Reform the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Protocol for Quality Improvement (Preprint)

“…Third, we surveyed 30 patients who received the consent process for the PICC procedure The questionnaire used for knowledge recall and knowledge retention was created based on recent guidelines for PICC [22][23][24][25][26][27][28][29][30][31][32] and included 3 "select one-answer" multiple-choice questions, 4 "select all that apply" multiple-choice questions, and 12 true/false questions. The knowledge recall questionnaire was administered within 4 -8 hours after the discussion between the vascular access team nurse and the patient and obtaining the signed consent.…”

“…Extensive work has been undertaken to test the effectiveness of PtDAs [3][4][5][6][7][8][9][10]. In a 2017 Cochrane review of 105 studies with 31,043 participants, the use of PtDAs helped patients feel clear about their personal values and improved the rate of patient engagement in the decision-making by reducing the proportions of undecided patients and passive decision makers compared to usual care [4]. In addition, the use of more detailed PtDAs and those with expressed risk probabilities resulted in a significant knowledge improvement and accurate risk perception compared to basic PtDAs [4].…”