Intensive Care Medicine

, Volume 38, Issue 2, pp 272–278 | Cite as

Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients

  • Thomas J. Wilson
  • Devin L. Brown
  • William J. Meurer
  • William R. StetlerJr.
  • D. Andrew Wilkinson
  • Jeffrey J. Fletcher
Original

Abstract

Purpose

Using Virchow’s triad as a framework, we sought to identify risk factors independently associated with symptomatic peripherally inserted central venous catheter (PICC)-related large vein thrombosis (PRLVT) in neurological intensive care patients.

Methods

A retrospective cohort study and detailed chart review were performed for 431 consecutive PICCs placed in patients admitted to our neurological intensive care unit between March 2008 and February 2010. Variables theorized to potentially increase the risk of PRLVT were abstracted from the medical record. Each variable was then tested for its independent association with PRLVT.

Results

During the study period, 431 PICCs were placed with an incidence rate for symptomatic thrombosis of 8.4%. In adjusted analysis, catheter placement in a paretic arm (OR, 9.85; 95% CI, 4.42–21.95), surgery longer than 1 h during dwell time of the catheter (OR, 3.26; 95% CI, 1.48–7.17), a history of venous thromboembolism (OR, 6.66; 95% CI, 2.38–18.62), and mannitol use (OR, 3.27; 95% CI 1.27–8.43) were independently associated with the development of thrombosis.

Conclusions

Alterations in blood flow and consistency, but not vessel injury, appear associated with symptomatic thrombosis following placement of PICCs in neurological intensive care patients. Mannitol use and placement in a paretic arm are potentially modifiable risk factors. Given the high incidence rate of symptomatic thrombosis, future studies should focus on comparing cumulative complications of centrally inserted venous catheters and PICCs in intensive care patients.

Keywords

Central venous catheterization Upper extremity deep venous thrombosis Secondary upper extremity deep vein thrombosis Venous thrombosis Central venous catheter thrombosis Venous thromboembolism 

Notes

Conflict of interest

The authors have no conflicts of interest or financial disclosures to declare.

Supplementary material

134_2011_2418_MOESM1_ESM.doc (27 kb)
Supplementary material 1 (DOC 27 kb)

References

  1. 1.
    Bernardi E, Piccioli A, Marchiori A, Girolami B, Prandoni P (2001) Upper extremity deep vein thrombosis: risk factors, diagnosis, and management. Semin Vasc Med 1:105–110PubMedCrossRefGoogle Scholar
  2. 2.
    Chemaly RF, de Parres JB, Rehm SJ, Adal KA, Lisgaris MV, Katz-Scott DS, Curtas S, Gordon SM, Steiger E, Olin J, Longworth DL (2002) Venous thrombosis associated with peripherally inserted central catheters: a retrospective analysis of the Cleveland Clinic experience. Clin Infect Dis 34:1179–1183PubMedCrossRefGoogle Scholar
  3. 3.
    Evans RS, Sharp JH, Linford LH, Lloyd JF, Tripp JS, Jones JP, Woller SC, Stevens SM, Elliott CG, Weaver LK (2010) Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest 138:803–810PubMedCrossRefGoogle Scholar
  4. 4.
    Grove JR, Pevec WC (2000) Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 11:837–840PubMedCrossRefGoogle Scholar
  5. 5.
    Lobo BL, Vaidean G, Broyles J, Reaves AB, Shorr RI (2009) Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters. J Hosp Med 4:417–422PubMedCrossRefGoogle Scholar
  6. 6.
    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 Enteral Nutr 32:443–447PubMedCrossRefGoogle Scholar
  7. 7.
    Paz-Fumagalli R, Miller YA, Russell BA, Crain MR, Beres RA, Mewissen MW (1997) Impact of peripherally inserted central catheters on phlebitic complications of peripheral intravenous therapy in spinal cord injury patients. J Spinal Cord Med 20:341–344PubMedGoogle Scholar
  8. 8.
    Schmittling ZC, McLafferty RB, Bohannon WT, Ramsey DE, Hodgson KJ (2004) Characterization and probability of upper extremity deep venous thrombosis. Ann Vasc Surg 18:552–557PubMedCrossRefGoogle Scholar
  9. 9.
    Trerotola SO, Stavropoulos SW, Mondschein JI, Patel AA, Fishman N, Fuchs B, Kolansky DM, Kasner S, Pryor J, Chittams J (2010) Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 256:312–320PubMedCrossRefGoogle Scholar
  10. 10.
    Bonizzoli M, Batacchi S, Cianchi G, Zagli G, Lapi F, Tucci V, Martini G, Di Valvasone S, Peris A (2011) Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 37:284–289PubMedCrossRefGoogle Scholar
  11. 11.
    Moser KM, Fedullo PF, LitteJohn JK, Crawford R (1994) Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA 271:223–225PubMedCrossRefGoogle Scholar
  12. 12.
    Prandoni P, Polistena P, Bernardi E, Cogo A, Casara D, Verlato F, Angelini F, Simioni P, Signorini GP, Benedetti L, Girolami A (1997) Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med 157:57–62PubMedCrossRefGoogle Scholar
  13. 13.
    Elman EE, Kahn SR (2006) The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review. Thromb Res 117:609–614PubMedCrossRefGoogle Scholar
  14. 14.
    Cheng JS, Arnold PM, Anderson PA, Fischer D, Dettori JR (2010) Anticoagulation risk in spine surgery. Spine (Phila Pa 1976) 35:S117–S124CrossRefGoogle Scholar
  15. 15.
    Gerber DE, Grossman SA, Streiff MB (2006) Management of venous thromboembolism in patients with primary and metastatic brain tumors. J Clin Oncol 24:1310–1318PubMedCrossRefGoogle Scholar
  16. 16.
    Jenkins EO, Schiff D, Mackman N, Key NS (2010) Venous thromboembolism in malignant gliomas. J Thromb Haemost 8:221–227PubMedCrossRefGoogle Scholar
  17. 17.
    Khaldi A, Helo N, Schneck MJ, Origitano TC (2011) Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population. J Neurosurg 114:40–46PubMedCrossRefGoogle Scholar
  18. 18.
    Kim KS, Brophy GM (2009) Symptomatic venous thromboembolism: incidence and risk factors in patients with spontaneous or traumatic intracranial hemorrhage. Neurocrit Care 11:28–33PubMedCrossRefGoogle Scholar
  19. 19.
    Lazio BE, Simard JM (1999) Anticoagulation in neurosurgical patients. Neurosurgery 45:838–848PubMedCrossRefGoogle Scholar
  20. 20.
    Taniguchi S, Fukuda I, Daitoku K, Minakawa M, Odagiri S, Suzuki Y, Fukui K, Asano K, Ohkuma H (2009) Prevalence of venous thromboembolism in neurosurgical patients. Heart Vessels 24:425–428PubMedCrossRefGoogle Scholar
  21. 21.
    Abdullah BJ, Mohammad N, Sangkar JV, Abd Aziz YF, Gan GG, Goh KY, Benedict I (2005) Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC). Br J Radiol 78:596–600PubMedCrossRefGoogle Scholar
  22. 22.
    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 11:1309–1314PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Thomas J. Wilson
    • 1
  • Devin L. Brown
    • 2
  • William J. Meurer
    • 3
  • William R. StetlerJr.
    • 1
  • D. Andrew Wilkinson
    • 1
  • Jeffrey J. Fletcher
    • 1
  1. 1.Department of NeurosurgeryUniversity of MichiganAnn ArborUSA
  2. 2.Department of NeurologyUniversity of MichiganAnn ArborUSA
  3. 3.Department of Emergency MedicineUniversity of MichiganAnn ArborUSA

Personalised recommendations