Intensive Care Medicine

, Volume 37, Issue 2, pp 284–289 | Cite as

Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients

  • Manuela Bonizzoli
  • Stefano Batacchi
  • Giovanni Cianchi
  • Giovanni ZagliEmail author
  • Francesco Lapi
  • Valentina Tucci
  • Giacomo Martini
  • Simona Di Valvasone
  • Adriano Peris



Peripherally inserted central venous catheters (PICC) have been proposed as an alternative to central venous catheters (CVC). The aim of this study was to determine the thrombosis rate in relation to PICC placement in patients discharged from the intensive care unit (ICU).


Data of patients admitted to the ICU (Careggi Teaching Hospital, Florence, Italy; January–August 2008) and discharged with a central venous device were sequentially studied. During the first 4 months, CVCs were used (CVC group), whereas during the last 4 months, PICCs were used (PICC group). Demographic/clinical and catheter-related data were collected. Intensivists performed Doppler examination at ICU discharge and 7, 15, and 30 days after placement.


Data of 239 patients were analyzed (125 of CVC group, 114 of PICC group). A total of 2,747 CVC-days and 4,024 PICC-days of observation were included. Patient characteristics were comparable between groups. Patients with PICC had a significantly higher incidence rate of deep venous thrombosis (DVT) than patients with CVC (27.2 vs. 9.6%, P = 0.0012). The rate of DVT/1,000 catheter days was 4.4 for CVCs and 7.7 for PICCs. Eighty percent of DVTs occurred within 2 weeks after insertion. Binary logistic analysis showed a two-fold increased risk for women and a three-fold increased risk when using the left basilic vein in the PICC group.


In our post-critically ill population, PICCs were associated with a higher rate of DVT complications than CVCs. Routine ultrasound surveillance for the first 2 weeks after patient discharge from the ICU with a PICC and preferential use of CVC for these patients may be warranted.


Peripherally inserted central venous catheters Central venous catheters Critically ill patients Deep venous thrombosis Post-intensive ward 


  1. 1.
    Vescia S, Baumgartner AK, Jacobs VR, Kiechle-Bahat M, Rody A, Loibl S, Harbeck N (2008) Management of venous port systems in oncology: a review of current evidence. Ann Oncol 19:9–15CrossRefPubMedGoogle Scholar
  2. 2.
    Tariq M, Huang DT (2006) PICCing the best access for your patient. Crit Care 10:315CrossRefPubMedGoogle Scholar
  3. 3.
    Safdar N, Maki DG (2005) Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 128:489–495CrossRefPubMedGoogle Scholar
  4. 4.
    Lam S, Scannell R, Roessler D, Smith MA (1994) Peripherally inserted central catheters in an acute-care hospital. Arch Intern Med 154:1833–1837CrossRefPubMedGoogle Scholar
  5. 5.
    Turcotte S, Dube S, Beauchamp G (2006) Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg 30:1605–1619CrossRefPubMedGoogle Scholar
  6. 6.
    Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, McDougall C, Wilcox MH (2001) Guidelines for preventing infections associated with the insertion and maintenance of central venous catheters. J Hosp Infect 47:S47–S67Google Scholar
  7. 7.
    O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 51:1–29PubMedGoogle Scholar
  8. 8.
    Galloway S, Sharma A, Ward J, Bodenham AR (2005) A review of an anaesthetic led vascular access list. Anaesthesia 60:772–778CrossRefPubMedGoogle Scholar
  9. 9.
    Allen AW, Megargell JL, Brown DB, Lynch FC, Singh H, Singh Y, Waybill PN (2000) Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 11:1309–1314CrossRefPubMedGoogle Scholar
  10. 10.
    Paauw JD, Borders H, Ingalls N, Boomstra S, Lambke S, Fedeson B, Goldsmith A, Davis AT (2008) The incidence of PICC line-associated thrombosis with and without the use of prophylactic anticoagulants. JPEN J Parenter Enter Nutr 32:443–447CrossRefGoogle Scholar
  11. 11.
    Prandoni P, Kahn SR (2009) Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol 145:286–295CrossRefPubMedGoogle Scholar
  12. 12.
    Gonsalves CF, Eschelman DJ, Sullivan KL, DuBois N, Bonn J (2003) Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol 26:123–127CrossRefPubMedGoogle Scholar
  13. 13.
    Weber TM, Lockhart ME, Robbin ML (2007) Upper extremity venous Doppler ultrasound. Radiol Clin North Am 45:513–524, viii–ixCrossRefPubMedGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Manuela Bonizzoli
    • 1
  • Stefano Batacchi
    • 1
  • Giovanni Cianchi
    • 1
  • Giovanni Zagli
    • 1
    Email author
  • Francesco Lapi
    • 2
    • 3
  • Valentina Tucci
    • 1
  • Giacomo Martini
    • 1
  • Simona Di Valvasone
    • 4
  • Adriano Peris
    • 1
  1. 1.Anesthesia and Intensive Care Unit of Emergency DepartmentCareggi Teaching HospitalFlorenceItaly
  2. 2.Department of Preclinical and Clinical PharmacologyUniversity of FlorenceFlorenceItaly
  3. 3.Epidemiology UnitRegional Agency for Health Care Services of TuscanyFlorenceItaly
  4. 4.Postgraduate School of Anesthesia and Intensive Care, Faculty of MedicineUniversity of FlorenceFlorenceItaly

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