Background: We have previously showed how implementing the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to inform peripherally inserted central catheter (PICC) use can lead to more appropriate device use. In this analysis, we assessed the association between appropriateness and PICC-related complications. We hypothesized that improved PICC appropriateness is associated with reduced major PICC complications [...]

Background: Deep vein thrombosis (DVT) is typically diagnosed from ultrasound (US) Doppler evaluation and anticoagulation therapy is the standard treatment to prevent life threatening pulmonary embolism (PE). In our hospital, the treating provider is alerted to the positive test result by phone and/or text in the imaging result. There is an absence of clinical decision [...]

Background: Deep vein thrombosis (DVT) is typically diagnosed from ultrasound (US) Doppler evaluation and anticoagulation therapy is the standard treatment to prevent life threatening pulmonary embolism (PE). In our hospital, the treating provider is alerted to the positive test result by phone and/or text in the imaging result. There is an absence of clinical decision [...]

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 [...]

Case Presentation: A 58-year-old-woman with no significant past medical history presented to her primary care physician with bilateral lower extremity edema. She was treated with compression stockings but returned after four months without improvement. She was diagnosed with chronic venous insufficiency and referred to a vascular surgeon for a superficial venous ablation, which was ineffective. [...]

Background: Cachexia and anorexia occur in 50-80% of cancer patients. In cancer patients, it is associated with shorter survival, treatment failure, early treatment termination, declining functional status, and reduced quality of life. Megestrol acetate is a synthetic derivative of progesterone commonly used to treat cancer-related cachexia. Megestrol use is associated with thromboembolism among other adverse [...]

Background: Patients with cancer require reliable venous access for therapy. Although peripherally inserted central catheters (PICCs) and implanted ports are often used to meet infusion needs, risk of complications between these devices is unknown. We did a systematic review and meta-analysis to compare the risk of deep vein thrombosis (DVT), exit-site complications and central line-associated [...]

Background: In-hospital venous thromboembolism (VTE) remains an important preventable cause of morbidity/mortality. Multiple risk assessment models (RAMs) for VTE in hospitalized medical patients have been developed, validated, and endorsed by several national societies. Despite evidence and guidelines supporting risk stratification for VTE prevention, data suggest that prophylactic measures are not appropriately utilized. In a nation-wide [...]

Background: Guidelines suggest venous thromboembolism risk stratification, and against use of prophylaxis in low risk medically ill hospitalized patients. Our hospital did not have a formal risk stratification process embedded into the electronic medical record (EMR) for provider use, and therefore it was common practice to administer pharmacologic prophylaxis to most medically ill patients regardless [...]

Background: Post operative VTE is higher among orthopedic surgeries when compared to other surgical fields. Within orthopedic surgery, hip and knee surgeries have the highest risk of post-op VTE. This risk is highest in the first 10 days but persists up to three months after surgery. Current American Academy of Orthopedic Surgeons (AAOS) guidelines recommend [...]