Background: Peripherally inserted central catheters (PICCs) are becoming increasingly popular due to their ease of insertion through upper extremity veins, although they are not complications-free. PICCs can be irritating and cause endothelial injury and inflammation resulting in venous thrombosis. Estimates suggest that more than a third of all deep venous thrombosis (DVT) in the upper extremities is caused by PICCs. This research highlights the incidence of DVT in patients with PICCs and the relation with other health conditions.
Methods: A retrospective study was conducted at a community hospital (343 beds). The records of 438 patients were reviewed from 2017 to 2020 (267 males, 171 females). Subjects were at least 18-years-old, underwent PICC insertion, and received outpatient parenteral antibiotic therapy (OPAT). The data included demographics and comorbidities, such as hypertension (HTN), diabetes (DM), chronic kidney disease (CKD), coronary artery disease (CAD), congestive heart failure (CHF), malignancy, previous DVT, and concomitant anticoagulation. The DVTs were confirmed by doppler ultrasound.
Results: DVTs were diagnosed in 24 patients (5.7%). The average age was 64.9 years. Seventeen patients(70%) were males and 24 (100%) were white. The median time to diagnosis was 21 days from PICC insertion. Patients with DM were 82% less likely to be diagnosed with DVT compared to those without diabetes (OR = 0.28, P= 0.008). There was no relation between the diagnosis of DVT and the other comorbidities, including HTN (OR = 0.45, P = 0.059), CAD (OR = 0.62, P = 0.353), CHF (OR = 0.87, P = 0.79), Afib (OR = 0.91, P = 0.589), concomitant anticoagulation (OR = 0.98, P = 0.62), CKD (OR = 1.16, P = 0.725), malignancy (OR = 1.83, P = 0.242), and previous DVT (OR = 1.2, P = 0.763). Age was not associated with higher risk of DVT (OR=1.6, P = 0.304).
Conclusions: The risk of DVT is 5.7 % in patients who have PICCs. The PICC was associated with less risk of DVT in patients with DM, while there was no risk association with HTN, CAD, CHF, Afib, concomitant anticoagulation, CKD, malignancy or previous DVT.
