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



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.


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.


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.


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.


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


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)


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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

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