Peripherally inserted central catheter‐related deep vein thrombosis: contemporary patterns and predictors

Summary Background Despite growing use, peripherally inserted central catheters ( PICC s) are associated with risk of deep vein thrombosis ( DVT ). We designed a study to determine patient, provider and device factors associated with this outcome. Methods This was a retrospective cohort study of adults who underwent PICC placement between 1 June 2009 to 30 June 2012. Symptomatic PICC ‐associated DVT was confirmed by ultrasound. Because PICC s are also recognized risk factors for lower‐extremity DVT , lower‐extremity DVT occurring while the PICC was in situ was included. Multivariable logistic and Cox‐proportional hazards regression models were fit to examine the association between covariates specified a priori and PICC ‐ DVT . Odds ratios ( ORs ) and hazard ratios ( HRs ) with corresponding 95% confidence intervals ( CIs ) were generated. Results Of 966 unique PICC placements, 33 patients developed symptomatic PICC ‐associated DVT and 9 developed lower‐extremity DVT , accounting for 42 thrombotic events. On bivariate analysis, recent diagnosis of cancer, interventional radiology placement, chemotherapy administration, number of lumens and PICC ‐gauge were associated with PICC ‐ DVT . Following multivariable adjustment, recent cancer diagnosis ( OR 1.95 [95% CI 1.01–3.76]) and PICC gauge ( HR 2.21 [95% CI 1.04–4.70] and HR 3.56 [95% CI 1.31–9.66] for 5‐Fr and 6‐Fr PICC s, respectively) remained associated with thrombosis. Conclusions Recent diagnosis of cancer and PICC gauge are associated with PICC ‐ DVT . These findings have important clinical ramifications and suggest that placement of large gauge PICC s or PICC s in patients with cancer may provoke thrombosis. Improved policies and procedural oversights in these areas appear necessary to prevent PICC ‐ DVT .