Study: PICCs double risk of deep vein thrombosis

By | 2013-05-25T00:00:00-04:00 May 25th, 2013|0 Comments

Compared with other central venous catheters, peripherally inserted central catheters more than double the risk of deep vein thrombosis, according to a study.

The risk especially increases among patients who are critically ill or who have cancer, reported researchers with the University of Michigan Health System.

In recent years, PICCs have become the preferred device through which to administer long-term intravenous fluids, antibiotics and other drugs because they have lower risk of infection, can be conveniently placed at the bedside and can stay in place for long periods of time, according to background information in the study, which was published May 20 on the website of The Lancet.

PICCs also are safer to insert, and the ability to keep PICCs in for weeks or even months allows patients who need a constant flow of medications to take the catheters home.

“Peripherally inserted central catheters have ushered in a new era of care and certainly the benefits of these devices are significant — but health providers should also be aware that they are not without their own risks and may not be appropriate for every patient,” Vineet Chopra, the study’s lead author and a hospitalist at UMHS, said in a news release.

“We’ve gravitated toward using this device over central venous catheters for good reasons, and it may still be the best choice for some people,” added Chopra, an assistant professor of internal medicine. “However, our findings suggest that patients and physicians should carefully review the risks and benefits when it comes to placing PICCs, especially with respect to blood clots. Our study shows that this risk may be higher than previously recognized and suggests that there is no one-size-fits-all approach when considering use of these devices.”

The researchers specifically analyzed the risks of deep vein thrombosis associated with PICCs relative to CVCs. Patients who received PICCs were more than twice as likely to develop blood clots as those who received CVCs. The frequency of PICC-associated deep vein thrombosis was greatest in patients in the ICU or those with cancer, populations already at high risk of clotting.

PICC-associated deep vein thrombosis is a potentially life-threatening condition that can lead to arm pain, arm swelling, venous damage, pulmonary embolism and possibly death. The rate of hospitalization for venous thromboembolism continues to climb in the U.S., with more than 330,000 hospital admissions for the condition in an average year.

“The paradox is the populations with the highest risks from this type of catheter are the ones who need them and use them the most,” said Scott Flanders, MD, MHM, the study’s senior author and a professor of internal medicine at U-M.

“Our findings suggest that the risks of developing blood clots from PICCs may be higher than most clinicians would suspect,” added Flanders, director of hospital medicine at U-M. “We clearly need to explore alternatives that may be safer and ways to prevent these clots in high-risk patients whose care requires this type of device.”

Read the study abstract: http://bit.ly/12P9TAh.

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