Experts from the University of Michigan Health System in Michigan, US have cautioned medical practitioners on the serious risks of upper extremity deep-vein thrombosis (DVT) for hospitalized patients with peripherally-inserted central catheter (PICC) lines.
PICC lines are intravenous (IV) devices inserted in a patient’s arm to provide a means of access for medicine, nutrition and to draw blood samples. These devices are usually maintained for days to months.
Dr. Vineet Chopra and colleagues studied the records of 909 adults who received PICCs at their hospital in 2012 and 2013. The PICC lines were used for long-term IV antibiotic therapy, obtaining blood samples and for providing total parenteral nutrition (TPN) in these patients. Of the 909, 268 patients developed clots associated with PICC. [Am J Med 2015; doi:10.1016/j.amjmed.2015.01.027]
PICC- associated DVT (PICC-DVT) was more likely to occur in subjects with history of venous thromboembolism (VTE) and those who underwent surgery while the PICC was in place.
Moreover, narrower PICCs and intake of both aspirin and statins were associated with low DVT risk. However, DVT prophylaxis did not show a significant reduction in the risk of PICC-DVT. Treatment for PICC-DVT included heparin bridging, low molecular weight heparin (LMWH) only, or device removal.
Based on these findings, the authors recommended that patients with PICCs be monitored for clots and advised to continue taking aspirin and statins. More importantly, PICCs should only be used when indicated.
This recommendation was supported by another paper published recently emphasizing the importance of knowing the types of venous access devices, their indications and contraindications and the relevant anatomy involved. The authors also outlined an algorithm to help clinicians in choosing the best vascular access for each patient. [Journal of Hospital Medicine 2015;doi: 10.1002/jhm.2335]
Chopra and colleagues also published a review of best practices to help reduce DVTs and ensure proper use of PICC in hospitals. Ultrasonography was found to be more specific and sensitive in detecting PICC-DVT than clinical symptoms alone. Contrast venography may also be used in cases with unremarkable ultrasonography findings and high clinical probability. PICCs that are centrally-positioned, functional and clinically necessary should not be removed in cases of concomitant DVT. The mainstay of treatment is anticoagulation with LMWH or warfarin for at least 3 months.