Anatomically Associated Venous Thromboembolism in Patients With Peripherally Inserted Central Catheters

2017 ◽  
Vol 22 (4) ◽  
pp. 182-187
Author(s):  
Travis Kimple ◽  
Niaman Nazir ◽  
Chad M. Cannon
Keyword(s):  
Venous Thromboembolism ◽  
International Classification Of Diseases ◽  
Tertiary Hospital ◽  
Peripherally Inserted Central Catheters ◽  
Vein Thrombosis ◽  
Icd9 Code ◽  
Classification Of Diseases ◽  
Clinically Significant ◽  
Deep Vein ◽  
Central Catheters

Abstract Background: Peripherally inserted central catheters (PICCs) are ubiquitous in modern hospitals, but are associated with venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and/or pulmonary embolism (PE). We retrospectively examined this association in hospitalized patients, highlighting anatomically associated VTEs (those with DVT in the PICC extremity). Methods: Charts with an International Classification of Diseases, Ninth Revision (ICD9) code for VTE were collected from a discharge database of PICC-managed patients at a tertiary hospital. A sample (52.3%) of the VTE charts was manually reviewed to verify PICC-associated VTE (unverified charts were excluded), and determine such data as the extremity in which each DVT was diagnosed (using ultrasound reports). VTE rates were calculated using an uncorrected method (from charts with VTE ICD9 code) and a corrected method (from charts with manually verified PICC-associated VTE). Results: Our uncorrected VTE rate was 3.9% (P < .0001), whereas the corrected rate was 1.5%. Among 125 charts with manually verified PICC-associated VTE, 69 (60.5%) out of 114 patients with a DVT had their DVT occur in the PICC extremity, yielding an anatomically associated VTE rate of 0.84%. The most common reason for a chart being excluded (60.2%) was a VTE occurring before PICC placement. Conclusions: We found clinically significant rates of PICC-associated VTE. The majority of patients' DVT occurred in the same extremity as their PICC, lending further evidence that PICCs are an independent risk factor for VTE and require judicious use. There was also a discrepancy in VTE rate derived from ICD codes alone vs. manual chart review.

scholarly journals Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children

2016 ◽  
Vol 14 (11) ◽  
pp. 2158-2168 ◽  
Author(s):  
J. J. Menéndez ◽  
C. Verdú ◽  
B. Calderón ◽  
A. Gómez-Zamora ◽  
C. Schüffelmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Peripherally Inserted Central Catheters ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Central Catheters

Peripherally inserted central catheters inserted with current best practices have low deep vein thrombosis and central line–associated bloodstream infection risk compared with centrally inserted central catheters: A contemporary meta-analysis

2020 ◽  
pp. 112972982091611 ◽  
Author(s):  
Gregory J Schears ◽  
Nicole Ferko ◽  
Imran Syed ◽  
John-Michael Arpino ◽  
Kimberly Alsbrooks
Keyword(s):  
Deep Vein Thrombosis ◽  
Best Practices ◽  
Meta Analysis ◽  
Central Line ◽  
Peripherally Inserted Central Catheters ◽  
Vein Thrombosis ◽  
Thrombosis Risk ◽  
Increased Risk ◽  
Deep Vein ◽  
Central Catheters

Background: Peripherally inserted central catheters and centrally inserted central catheters have numerous benefits but can be associated with risks. This meta-analysis compared central catheters for relevant clinical outcomes using recent studies more likely to coincide with practice guidelines. Methods: Several databases, Ovid MEDLINE, Embase, and EBM Reviews were searched for articles (2006–2018) that compared central catheters. Analyses were limited to peer-reviewed studies comparing peripherally inserted central catheters to centrally inserted central catheters for deep vein thrombosis and/or central line–associated bloodstream infections. Subgroup, sensitivity analyses, and patient-reported measures were included. Risk ratios, incidence rate ratios, and weighted event risks were reported. Study quality assessment was conducted using Newcastle–Ottawa and Cochrane Risk of Bias scales. Results: Of 4609 screened abstracts, 31 studies were included in these meta-analyses. Across studies, peripherally inserted central catheters were protective for central line–associated bloodstream infection (incidence rate ratio = 0.52, 95% confidence interval: 0.30–0.92), with consistent results across subgroups. Peripherally inserted central catheters were associated with an increased risk of deep vein thrombosis (risk ratio = 2.08, 95% confidence interval: 1.47–2.94); however, smaller diameter and single-lumen peripherally inserted central catheters were no longer associated with increased risk. The absolute risk of deep vein thrombosis was calculated to 2.3% and 3.9% for smaller diameter peripherally inserted central catheters and centrally inserted central catheters, respectively. On average, peripherally inserted central catheter patients had 11.6 more catheter days than centrally inserted central catheter patients ( p = 0.064). Patient outcomes favored peripherally inserted central catheters. Conclusion: When adhering to best practices, this study demonstrated that concerns related to peripherally inserted central catheters and deep vein thrombosis risk are minimized. Dramatic changes to clinical practice over the last 10 years have helped to address past issues with central catheters and complication risk. Given the lower rate of complications when following current guidelines, clinicians should prioritize central line choice based on patient therapeutic needs, rather than fear of complications. Future research should continue to consider contemporary literature over antiquated data, such that it recognizes the implications of best practices in modern central catheterization.

Five-year outcome of peripherally inserted central catheters in adults: a separated infectious and thrombotic complications analysis

2020 ◽  
pp. 1-9
Author(s):  
Samuel González ◽  
Pedro Jiménez ◽  
Pedro Saavedra ◽  
Desiré Macías ◽  
Ana Loza ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Tertiary Care ◽  
Infectious Complications ◽  
Incidence Density ◽  
Peripherally Inserted Central Catheters ◽  
Vein Thrombosis ◽  
Crude Mortality Rate ◽  
Thrombotic Complications ◽  
Deep Vein ◽  
Central Catheters

Abstract Objective: To assess infectious and thrombotic complications of peripherally inserted central catheters (PICCs) in adults. Design: A 5-year prospective cohort study. Setting: Tertiary-care teaching hospital in Seville, Spain. Patients: Adult patients undergoing PICC insertion. Methods: Catheter-associated bloodstream infection (CABSI) including catheter-related bloodstream infection (CRBSI), primary bacteremia (PB), and upper extremity deep vein thrombosis (UEDVT) were recorded. Independent predictors of complications were assessed by multivariate analysis. Results: In total, 1,142 PICCs were inserted, with 153,191 catheter days (median, 79). Complications included 66 cases of CABSI (5.78%; 0.43‰ catheter days), 38 cases of CRBSI (3.33%; 0.25‰ catheter days), 28 cases of PB (2.45%; 0.18‰ catheter days), and 23 cases of UEDVT (2.01%; 0.15‰ catheter days). The median times to infection were 24, 41, and 60 days for CRBSI, PB, and UEDVT, respectively. Parenteral nutrition (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.77–6.52) and admission to the hematology ward (OR, 4.90; 95% CI, 2.25–10.71) were independently associated with CRBSI and PB, respectively. Admission to the hematology ward (OR, 12.46; 95% CI, 2.49–62.50) or to the oncology ward (OR, 7.89; 95% CI, 1.77–35.16) was independently associated with UEDVT. The crude mortality rate was 24.8%. Only 2 patients died of complications. Conclusions: PICCs showed a low rate of thrombotic and infectious complications. Compared to PB, CRBSI showed significantly different risk factors, a higher incidence density per catheter days, and a shorter median time to infection. Separate analyses of CRBSI and PB are more specific and clinically useful when analyzing infectious complications.

scholarly journals Prevalence of Venous Thromboembolism in Kumasi: A Postmortem-Based Study in a Tertiary Hospital in Ghana

2020 ◽  
Vol 14 ◽  
pp. 117954842095636
Author(s):  
Paul Poku Sampene Ossei ◽  
Isaac Kofi Owusu ◽  
Gerald Owusu-Asubonteng ◽  
Frank Ankobea-Kokroe ◽  
William Gilbert Ayibor ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
The Elderly ◽  
Tertiary Hospital ◽  
Distribution Analysis ◽  
Age Group ◽  
Major Health Problem ◽  
Vein Thrombosis ◽  
Deep Vein

Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghana. Knowledge of the prevalence of venous thromboembolism, which is often undetected clinically, will help save lives as appropriate interventions can be made as well as provide a general clue to clinicians on detecting venous thromboembolism and pulmonary embolism. Methods: The study employs a retrospective design with data extracted from the Autopsy Daybook of the Pathology unit, Komfo Anokye Teaching Hospital, 2009 to 2016. Data on patients’ demographics were retrieved to establish diagnoses and age and gender distribution. Analysis was made of pulmonary embolism and deep vein thrombosis as a cause of death recorded on death certificates using the criteria of the International Classification of Diseases, version 10. Results: A total of 150 cases of deep vein thrombosis and/or pulmonary embolism were available for the study period and the results showed an average age of 45.3 years with a standard deviation of 19.96. The ages ranged between 3 years and 96 years with the age group 31 to 40 years being the modal age group. Males recorded the highest number of cases with 92 (59.35%) compared to females with 63 (40.65%). Respiratory disorders, of which pneumonia is the most prevalent, are the leading clinical condition that is often misdiagnosed in place of pulmonary thromboembolism. Conclusion: VTE is a major health problem especially among the elderly, but unfortunately the clinical diagnosis is usually missed by clinicians hence the need to maintain a high suspicion index.

Sign in / Sign up

Export Citation Format

Share Document