Peripherally Inserted Central Catheters and Upper Extremity Deep Venous Thrombosis: Incidence and Risk Factors
Author(s): Batayneh O, Mahfouz R, Rabinovich D, Zainah H
Introduction: 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 deep venous thrombosis (DVT). Estimates suggest that more than a third of all DVT in the upper extremities is caused by PICCs. This research highlights the incidence of upper extremity DVT in patients with PICCs and the relation with other comorbidities.
Methods: A retrospective matched cohort was cond- conducted at a community hospital. The records of 438 patients were reviewed from 2017 to 2020. 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 mellitus (DM), chronic kidney disease (CKD), coronary artery disease (CAD), congestive heart failure (CHF), active 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 (70%) patients were males and 24 (100%) were white. The median time to diagnosis was 21 days from PICC insertion. Patients with DM were 72% 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).
Conclusion: The risk of DVT was 5.7 % in patients who had PICCs. There was less risk of DVT in patients with diabetes mellitus, while there was no risk association with the other comorbidities.