Skip to main content
SpringerLink
Log in

Sequential Pneumatic Compression in the Arm in Neurocritical Patients with a Peripherally Inserted Central Venous Catheter: A Randomized Trial

  • Original Work
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Peripherally inserted central venous catheters (PICCs) are increasingly used for parenteral access in critically ill hospitalized patients, but they increase the incidence of upper extremity deep venous thrombosis (UE DVT). Sequential compression devices (SCDs) applied to the legs effectively reduce lower extremity DVT, but have not been tested in the arms. Our objective was to determine whether SCDs applied to the arm may reduce the risk of PICC-associated UE DVT.

Methods

This was a retrospective study of randomized, single-center, controlled clinical trial on patients hospitalized in the intensive care unit with critical neurological illness who had a PICC and were not receiving anticoagulants. Between January 2014 and October 2016, patients were randomized 1:1 to an intervention group having a custom SCD applied to the arm harboring the PICC or to a control group. The primary endpoint was ultrasound-detected UE DVT.

Results

Following randomization of 77 subjects, the study was terminated due to excess DVT in the treatment arm. UE DVT was detected in 18 subjects (29.0%), and it was more frequent among those in the SCD group (13/31 [41.9%] vs. the control group 5/31 [16.1%]; p = 0.049). After accounting for crossovers, the difference was still significant (12/28 [43.0%] vs. 6/34 [17.6%]; p = 0.048). Yet, symptomatic UE DVT (n = 3) and pulmonary embolism without evidence of lower extremity DVT (n = 2) were only observed in patients who were not wearing the SCD on the arm.

Conclusions

Although UE DVT is commonly associated with PICC use, the results of this trial do not support the use of SCD on the arm for DVT prevention. Further research on this strategy may nonetheless be justified.

Trial Registration

This trial was registered in ClinicalTrials.gov under the identifier NCT01670188.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Johansson E, Hammarskjold F, Lundberg D, Arnlind MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: a systematic review of the literature. Acta Oncol. 2013;52:886–92.

    Article  Google Scholar 

  2. Horattas MC, Trupiano J, Hopkins S, Pasini D, Martino C, Murty A. Changing concepts in long-term central venous access: catheter selection and cost savings. Am J Infect Control. 2001;29:32–40.

    Article  CAS  Google Scholar 

  3. Bonizzoli M, Batacchi S, Cianchi G, et al. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med. 2011;37:284–9.

    Article  Google Scholar 

  4. Meyer BM. Developing an alternative workflow model for peripherally inserted central catheter placement. J Infus Nurs. 2012;35:34–42.

    Article  Google Scholar 

  5. Chopra V, Anand S, Hickner A, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. The Lancet. 2013;382:311–25.

    Article  Google Scholar 

  6. Fallouh N, McGuirk HM, Flanders SA, Chopra V. Peripherally inserted central catheter-associated deep vein thrombosis: a narrative review. Am J Med. 2015;128:722–38.

    Article  Google Scholar 

  7. Fletcher JJ, Stetler W, Wilson TJ. The clinical significance of peripherally inserted central venous catheter-related deep vein thrombosis. Neurocrit Care. 2011;15:454–60.

    Article  Google Scholar 

  8. Nolan ME, Yadav H, Cawcutt KA, Cartin-Ceba R. Complication rates among peripherally inserted central venous catheters and centrally inserted central catheters in the medical intensive care unit. J Crit Care. 2016;31:238–42.

    Article  Google Scholar 

  9. Wilson TJ, Brown DL, Meurer WJ, Stetler WR Jr, Wilkinson DA, Fletcher JJ. Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients. Intensive Care Med. 2012;38:272–8.

    Article  Google Scholar 

  10. Winters JP, Callas PW, Cushman M, Repp AB, Zakai NA. Central venous catheters and upper extremity deep vein thrombosis in medical inpatients: the Medical Inpatients and Thrombosis (MITH) Study. J Thromb Haemost. 2015;13:2155–60.

    Article  CAS  Google Scholar 

  11. Joffe HV, Kucher N, Tapson VF, Goldhaber SZ, Deep Vein Thrombosis FSC. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation. 2004;110:1605–11.

    Article  Google Scholar 

  12. Kucher N. Clinical practice. Deep-vein thrombosis of the upper extremities. N Engl J Med. 2011;364:861–9.

    Article  CAS  Google Scholar 

  13. Collaboration CT, Dennis M, Sandercock P, et al. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet. 2013;382:516–24.

    Article  Google Scholar 

  14. Roderick P, Ferris G, Wilson K, et al. Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technol Assess. 2005;9:iii–iv, ix–x, 1–78.

  15. Lippi G, Favaloro EJ, Cervellin G. Prevention of venous thromboembolism: focus on mechanical prophylaxis. Semin Thromb Hemost. 2011;37:237–51.

    Article  Google Scholar 

  16. Kohro S, Yamakage M, Sato K, Sato JI, Namiki A. Intermittent pneumatic foot compression can activate blood fibrinolysis without changes in blood coagulability and platelet activation. Acta Anaesthesiol Scand. 2005;49:660–4.

    Article  CAS  Google Scholar 

  17. Knight MT, Dawson R. Proceedings: reduction of the incidence of deep vein thrombosis (DVT) in the legs by intermittent compression of the arms. Br J Surg. 1976;63:668.

    CAS  PubMed  Google Scholar 

  18. Trerotola SO, Stavropoulos SW, Mondschein JI, et al. Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology. 2010;256:312–20.

    Article  Google Scholar 

  19. Chopra V, Ratz D, Kuhn L, Lopus T, Lee A, Krein S. Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors. J Thromb Haemost. 2014;12:847–54.

    Article  CAS  Google Scholar 

  20. Chopra V, Kaatz S, Conlon A, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. J Thromb Haemost. 2017;15:1951–62.

    Article  CAS  Google Scholar 

  21. Mermis JD, Strom JC, Greenwood JP, et al. Quality improvement initiative to reduce deep vein thrombosis associated with peripherally inserted central catheters in adults with cystic fibrosis. Ann Am Thorac Soc. 2014;11:1404–10.

    Article  Google Scholar 

  22. Evans RS, Sharp JH, Linford LH, et al. Reduction of peripherally inserted central catheter-associated DVT. Chest. 2013;143:627–33.

    Article  Google Scholar 

  23. Nyquist P, Bautista C, Jichici D, et al. Prophylaxis of venous thrombosis in neurocritical care patients: an evidence-based guideline: a statement for healthcare professionals from the neurocritical care society. Neurocrit Care. 2016;24:47–60.

    Article  Google Scholar 

  24. Kirkpatrick A, Rathbun S, Whitsett T, Raskob G. Prevention of central venous catheter-associated thrombosis: a meta-analysis. Am J Med. 2007;120(901):e901–13.

    Google Scholar 

  25. Chopra V, Fallouh N, McGuirk H, et al. Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: a nested case-control study. Thromb Res. 2015;135:829–34.

    Article  CAS  Google Scholar 

Download references

Funding

Funding was provided by DJO Global.

Author information

Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 200 First Street SW., Rochester, MN, 55905, USA

    Alejandro A. Rabinstein

  2. Department of Nursing, Mayo Clinic, Rochester, MN, USA

    Jodi D. Hellickson

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Thanila A. Macedo & Bradley D. Lewis

  4. Department of Health Sciences Research (Division of Biomedical Statistics and Informatics), Mayo Clinic, Rochester, MN, USA

    Jay Mandrekar

  5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Robert D. McBane II

Authors
  1. Alejandro A. Rabinstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jodi D. Hellickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thanila A. Macedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bradley D. Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jay Mandrekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert D. McBane II
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AAR contributed study design, enrollment of subjects and manuscript preparation. JDH contributed enrollment of subjects and review of the manuscript. JM contributed statistical analysis and review of the manuscript. TAM contributed data collection (ultrasound read) and review of the manuscript. BDL contributed data collection (ultrasound read) and review of the mansucript. RDM contributed review of the manuscript.

Corresponding author

Correspondence to Alejandro A. Rabinstein.

Ethics declarations

Conflicts of Interest

Alejandro A. Rabinstein received support from DJO Global for the conduction of the study (without personal remuneration). Jodi D. Hellickson, Thanila A. Macedo, Bradley D. Lewis, Jay Mandrekar, and Robert D. McBane II declare that they have no conflict of interest.

Ethical Approval/Informed Consent

The study was approved by the Mayo Clinic Institutional Review Board. All participants were enrolled into the study after they or they surrogate provided written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rabinstein, A.A., Hellickson, J.D., Macedo, T.A. et al. Sequential Pneumatic Compression in the Arm in Neurocritical Patients with a Peripherally Inserted Central Venous Catheter: A Randomized Trial. Neurocrit Care 32, 187–192 (2020). https://doi.org/10.1007/s12028-019-00765-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-019-00765-w

Keywords

Search

Navigation