The Association Between PICC Use and Venous Thromboembolism in Upper and Lower Extremities - 31/08/15
Abstract |
Background |
Peripherally inserted central catheters are associated with upper-extremity deep vein thrombosis. Whether they also are associated with lower-extremity deep vein thrombosis or pulmonary embolism is unknown. We examined the risk of venous thromboembolism in deep veins of the arm, leg, and chest after peripherally inserted central catheter placement.
Methods |
We conducted a multicenter, retrospective cohort study of 76,242 hospitalized medical patients from 48 Michigan hospitals. Peripherally inserted central catheter presence, comorbidities, venous thrombosis risk factors, and thrombotic events within 90 days from hospital admission were ascertained by phone and record review. Cox proportional hazards models were fit to examine the association between peripherally inserted central catheter placement and 90-day hazard of upper- and lower-extremity deep vein thrombosis or pulmonary embolism, adjusting for patient-level characteristics and natural clustering within hospitals.
Results |
A total of 3790 patients received a peripherally inserted central catheter during hospitalization. From hospital admission to 90 days, 876 thromboembolic events (208 upper-extremity deep vein thromboses, 372 lower-extremity deep vein thromboses, and 296 pulmonary emboli) were identified. After risk adjustment, peripherally inserted central catheter use was independently associated with all-cause venous thromboembolism (hazard ratio [HR], 3.16; 95% confidence interval [CI], 2.59-3.85), upper-extremity deep vein thrombosis (HR, 10.49; 95% CI, 7.79-14.11), and lower-extremity deep vein thrombosis (HR, 1.48; 95% CI, 1.02-2.15). Peripherally inserted central catheter use was not associated with pulmonary embolism (HR, 1.34; 95% CI, 0.86-2.06). Results were robust to sensitivity analyses incorporating receipt of pharmacologic prophylaxis during hospitalization.
Conclusions |
Peripherally inserted central catheter use is associated with upper- and lower-extremity deep vein thrombosis. Weighing the thrombotic risks conferred by peripherally inserted central catheters against clinical benefits seems necessary.
Le texte complet de cet article est disponible en PDF.Keywords : Deep vein thrombosis, Peripherally inserted central catheter, Venous thromboembolism
Plan
| Funding: This study was funded by Blue Cross Blue Shield of Michigan. Other than research support, no compensation was received for this project. VC is supported by a career development award from the Agency for Healthcare Research and Quality (1K08HS022835-01). Blue Cross Blue Shield of Michigan supported data collection at each participating site and funded the data coordinating center but had no role in the study concept, interpretation of findings, or preparation, review, or final approval of the manuscript. |
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| Conflict of Interest: SAF discloses consultancies for the Institute for Healthcare Improvement and the Society of Hospital Medicine; royalties from Wiley Publishing; honoraria for various talks at hospitals as a visiting professor; grants from the Centers for Disease Control Foundation, Blue Cross Blue Shield of Michigan, and Michigan Hospital Association; and expert witness testimony. SCW discloses serving as a panelist for the American College of Chest Physicians Clinical Practice Guideline: Antithrombotic Therapy for Venous Thromboembolic Disease (AT10). SJB discloses memberships in the Blue Care Network Statewide Clinical Quality Committee and the Blue Care Network Medical Leadership Council. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 128 - N° 9
P. 986 - septembre 2015 Retour au numéro
Article précédent
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