Peripherally inserted central catheter usage patterns and associated symptomatic upper extremity venous thrombosis.

OBJECTIVES: Peripherally inserted central catheters (PICCs) may be complicated by upper extremity (UE) superficial (SVT) or deep venous thrombosis (DVT). The purpose of this study was to determine current PICC insertion patterns and if any PICC or patient characteristics were associated with venous thrombotic complications. METHODS: All UE venous duplex scans during a 12-month period were reviewed, selecting patients with isolated SVT or DVT and PICCs placed ≤30 days. All UE PICC procedures during the same period were identified from an electronic medical record query. PICC-associated DVTs, categorized by insertion site, were compared with all first-time UE PICCs to determine the rate of UE DVT and isolated UE SVT. Technical and clinical variables in patients with PICC-associated UE DVT also were compared with 172 patients who received a PICC without developing DVT (univariable and multivariable analysis). RESULTS: We identified 219 isolated UE SVTs and 154 UE DVTs, with 2056 first-time UE PICCs placed during the same period. A PICC was associated with 44 of 219 (20%) isolated UE SVTs and 54 of 154 UE DVTs (35%). The rates of PICC-associated symptomatic UE SVT were 1.9% for basilic, 7.2% for cephalic, and 0% for brachial vein PICCs. The rates of PICC-associated symptomatic UE DVT were 3.1% for basilic, 2.2% for brachial, and 0% for cephalic vein PICCs (χ(2)P < .001). Univariate analysis of technical and patient variables demonstrated that larger PICC diameter, noncephalic insertion, smoking, concurrent malignancy, diabetes, and older age were associated with UE DVT (P < .05). Multivariable analysis showed larger catheter diameter and malignancy were the only variables associated with UE DVT (P < .05). CONCLUSIONS: The incidence of symptomatic PICC-associated UE DVT is low, but given the number of PICCs placed each year, they account for up to 35% of all diagnosed UE DVTs. Larger-diameter PICCs and malignancy increase the risk for DVT, and further studies are needed to evaluate the optimal vein of first choice for PICC insertion.

Symptomatic perioperative venous thromboembolism is a frequent complication in patients with a history of deep vein thrombosis.

OBJECTIVES: Patients who undergo surgery are at risk for venous thromboembolism (VTE), and a history of prior deep vein thrombosis (DVT) increases that risk. This study determined the incidence and risk factors for symptomatic perioperative VTE in patients with a prior diagnosis of DVT. METHODS: All lower extremity DVTs, diagnosed between January 2002 and December 2006, were identified through a vascular database. Patients who had subsequent surgery were reviewed. The following data were evaluated: location of DVT, time interval between DVT and surgery, type of surgery, common clinical VTE risk factors, postoperative venous duplex scans, computed tomography (CT) scans of the chest, and ventilation-perfusion scans. RESULTS: A total of 372 patients with prior DVT underwent 1081 subsequent surgical procedures. One hundred nine patients undergoing 211 procedures had a follow-up venous duplex scan within 30 days after surgery. Of them, 46% received an inferior vena caval (IVC) filter, and pulmonary emboli were diagnosed in 3 patients (<1%). Overall, 24% of the patients developed DVT extension or new-site DVT in the perioperative period. The median time interval between the original DVT and surgery was 1.5 weeks in patients with DVT recurrence and 4 weeks in patients without recurrence (P = .22, Mann-Whitney). High-risk surgeries were associated with a >three-fold increased risk for recurrence, when compared with low-risk procedures (34% vs 11%; P = .009, chi(2)). Perioperative VTE recurrence was not influenced by the location of the original thrombus or other VTE risk factors. CONCLUSION: In patients with prior DVT, perioperative symptomatic recurrence is common and is associated with high-risk procedures. A longer time interval between a DVT episode and subsequent surgery may decrease the risk of recurrence, but large clinical trials are needed to confirm this. Further prospective evaluations are needed to identify and treat patients at greatest risk for recurrence.