PICCS May Double Risk for Clots in Critically Ill Patients

Peripherally inserted central catheters (PICCs) may double the risk for deep vein thrombosis compared with central venous catheters (CVCs), according to a new systematic review and meta-analysis. This is particularly true for patients who have a malignancy or are critically ill. Pulmonary embolism remains infrequent, despite the prevalence of deep vein thrombosis.

Vineet Chopra, MD, from the University of Michigan Health System in Ann Arbor, and colleagues present the results of their systematic review in an article published online May 20 in the Lancet. It represents the largest review of the incidence, patterns, and risk for venous thromboembolism associated with PICCs. The review was limited by the fact that there are no published randomised trials.

The authors identified 533 citations, of which 64 studies met the eligibility criteria. The included studies encompassed 29,503 patients.

The authors found that the frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill (13.91%; 95% confidence interval, 7.68% - 20.14%) and patients with cancer (6.67%; 95% confidence interval, 4.69% - 8.64%). The authors propose that the elevated risk associated with PICCS may be a result of PICCs being inserted into peripheral veins that are narrower and more likely to occlude in the presence of a catheter than the large veins used for CVCs.

"Although we recorded no significant difference in the frequency of deep vein thrombosis between studies that used prophylaxis and those that did not, our ability to discern benefit is limited by the scarcity of systematic reporting about prophylaxis," the authors write. "Although our findings agree with previous reviews in this regard, our results also suggest that PICC-related deep vein thrombosis is more common than is clinically realized, remaining undetected in many cases. In this context, non-pharmacological methods such as early catheter removal and guidance to appropriately place PICCs might be relevant in the prevention of PICC-associated deep vein thrombosis."

The authors recommend a thoughtful consideration of whether or not to insert PICCs in patients with cancer or critical illness.

The authors have disclosed no relevant financial relationships.

Lancet. Published online May 20, 2013. Abstract

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