Reduction of peripherally inserted central catheter-associated DVT.

BACKGROUND: As peripherally inserted central catheter (PICC) use has increased, so has the upper extremity DVT rate. PICC diameter may pose the most modifiable risk for PICC-associated DVT. METHODS: A 3-year, prospective, observational study of all PICC insertions by a specially trained and certified team using a consistent and replicable approach was conducted at a 456-bed, level I trauma and tertiary referral hospital during January 1, 2008, through December 31, 2010. An intensified effort by the PICC team in 2010 was introduced to discuss and reach interdisciplinary consensus on the need for each lumen of the PICC and a change to smaller diameter 5F triple-lumen PICC. RESULTS: Significantly more 4F single-lumen PICCs were used during 2010 (n = 470) compared with 2008 and 2009 (n = 338, 382; P < .0001). DVT rates were similar with the use of 5F triple-lumen PICCs in 2010 as 5F double-lumen PICCs and lower rates than 6F triple-lumen catheters used in 2008 and 2009. The PICC-associated DVT rate was significantly lower (1.9% vs 3.0%, P < .04) in 2010 compared with 2008 and 2009. The cost and length of stay attributable to PICC-associated DVT were $15,973 and 4.6 days. CONCLUSIONS: A significant increase in the use of single-lumen PICCs in addition to the institutional adoption of smaller 5F triple-lumen PICCs was associated with a significant decrease in the rate of PICC-associated DVT.

Risk of symptomatic DVT associated with peripherally inserted central catheters.

BACKGROUND: Previous studies undertaken to identify risk factors for peripherally inserted central catheter (PICC)-associated DVT have yielded conflicting results. PICC insertion teams and other health-care providers need to understand the risk factors so that they can develop methods to prevent DVT. METHODS: A 1-year prospective observational study of PICC insertions was conducted at a 456-bed, level I trauma center and tertiary referral hospital affiliated with a medical school. All patients with one or more PICC insertions were included to identify the incidence and risk factors for symptomatic DVT associated with catheters inserted by a facility-certified PICC team using a consistent and replicated approach for vein selection and insertion. RESULTS: A total of 2,014 PICCs were inserted during 1,879 distinct hospitalizations in 1,728 distinct patients for a total of 15,115 days of PICC placement. Most PICCs were placed in the right arm (76.9%) and basilic vein (74%) and were double-lumen 5F (75.3%). Of the 2,014 PICC insertions, 60 (3.0%) in 57 distinct patients developed DVT in the cannulated or adjacent veins. The best-performing predictive model for DVT (area under the curve, 0.83) was prior DVT (odds ratio [OR], 9.92; P < .001), use of double-lumen 5F (OR, 7.54; P < .05) or triple-lumen 6F (OR, 19.50; P < .01) PICCs, and prior surgery duration of > 1 h (OR, 1.66; P = .10). CONCLUSIONS: Prior DVT and surgery lasting > 1 h identify patients at increased risk for PICC-associated DVT. More importantly, increasing catheter size also is significantly associated with increased risk. Rates of PICC-associated DVT may be reduced by improved selection of patients and catheter size.

Computer identification of symptomatic deep venous thrombosis associated with peripherally inserted venous catheters.

Peripherally inserted central catheters (PICCs) are considered a safe method to provide long-term antibiotic therapy, chemotherapy and nutrition support. Deep venous thrombosis (DVT) is a complication that requires early PICC removal, may extend hospitalization and can result in pulmonary embolism. PICC insertion teams strive to understand risk factors and develop methods to prevent DVTs. However, they can only manage what they can measure. At LDS Hospital, identification of PICC associated DVTs was dependent on verbal notification or manual surveillance of more than a thousand free-text vascular reports. Accurate DVT rates were not known which hindered prevention. We describe the development of a computer application (PICC-DVT monitor) to identify PICC associated DVTs each day. A one-year evaluation of the monitor by the PICC team and a review of 445 random vascular reports found a positive predictive value of 98%, sensitivity of 94%, specificity of 100% and a PICC team associated DVT rate of 2.8%.