PICC Use May Cause Blood Clots in All Extremities

A new study indicates that peripherally inserted central catheters (PICCs) could potentially lead to deep vein thrombosis (DVT) in the lower extremities, as well as the upper ones.

Researchers at the at the University of Michigan (Ann Arbor, USA) and other institutions participating in the Michigan Hospital Medicine Safety Consortium (Ann Arbor, MI, USA) conducted a multicenter, retrospective cohort study of 76,242 hospitalized medical patients from 48 Michigan hospitals to examine the risk of DVT in deep veins of the arm, leg, and chest after PICC placement. The main outcomes were thrombotic events within 90 days from hospital admission, as ascertained by phone and record review.

In all, 3,790 patients received a PICC during hospitalization. Analysis revealed 876 thromboembolic events, including 208 upper-extremity DVTs, 372 lower-extremity DVTs, and 296 pulmonary emboli (PE). After adjustment, PICC use was independently associated with a three-fold higher risk for any type of thromboembolic event, compared to patients who had not received a PICC. DVT risk was more than 10 times higher in the upper extremity and nearly 50% higher in the lower-extremity DVT. There was no increased risk of pulmonary embolism from PICC use. The study was published on May 1, 2015, in the American Journal of Medicine.

“Careful weighing of the risks and benefits of PICC use and consideration of alternative devices in patients at high risk of deep vein thrombosis seem essential,” concluded senior author Vineet Chopra, MD, MSc, and colleagues. “Clinicians should not focus only on the extremity where a peripherally inserted central catheter resides, but the composite risk of venous thromboembolism among patients who receive a peripherally inserted central catheter.”

PICCs have become the preferred device through which to administer long-term intravenous (IV) fluids, antibiotics, and other drugs because they have lower risks of infection, can be conveniently placed at the bedside, and can stay in place for long periods of time. The ability to keep PICCs in for weeks or even months also allows patients who need a constant flow of medications to go home with these catheters.

Related Links:
University of Michigan
The Michigan Hospital Medicine Safety Consortium