Vineet Chopra1, Scott Kaatz2, Paul Grant3, Lakshmi Swaminathan4, Tanya Boldenow5, Anna Conlon6, Steven J Bernstein7, Scott A Flanders3. 1. Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Health Care System, Mich; Michigan Hospital Medicine Safety Consortium, Ann Arbor. Electronic address: vineetc@umich.edu. 2. Henry Ford Health System, Detroit, Mich. 3. Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Michigan Hospital Medicine Safety Consortium, Ann Arbor. 4. Beaumont Hospital, Dearborn, Mich. 5. St. Josephs Health Center, Ypsilanti, Mich. 6. Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Health Care System, Mich. 7. Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Health Care System, Mich; Michigan Hospital Medicine Safety Consortium, Ann Arbor; Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
Abstract
BACKGROUND: Catheter exchange over a guidewire is frequently performed for malfunctioning peripherally inserted central catheters (PICCs). Whether such exchanges are associated with venous thromboembolism is not known. METHODS: We performed a retrospective cohort study to assess the association between PICC exchange and risk of thromboembolism. Adult hospitalized patients that received a PICC during clinical care at one of 51 hospitals participating in the Michigan Hospital Medicine Safety consortium were included. The primary outcome was hazard of symptomatic venous thromboembolism (radiographically confirmed upper-extremity deep vein thrombosis and pulmonary embolism) in those that underwent PICC exchange vs those that did not. RESULTS: Of 23,010 patients that underwent PICC insertion in the study, 589 patients (2.6%) experienced a PICC exchange. Almost half of all exchanges were performed for catheter dislodgement or occlusion. A total of 480 patients (2.1%) experienced PICC-associated deep vein thrombosis. The incidence of deep vein thrombosis was greater in those that underwent PICC exchange vs those that did not (3.6% vs 2.0%, P < .001). Median time to thrombosis was shorter among those that underwent exchange vs those that did not (5 vs 11 days, P = .02). Following adjustment, PICC exchange was independently associated with twofold greater risk of thrombosis (hazard ratio [HR] 1.98; 95% confidence interval [CI], 1.37-2.85) vs no exchange. The effect size of PICC exchange on thrombosis was second in magnitude to device lumens (HR 2.06; 95% CI, 1.59-2.66 and HR 2.31; 95% CI, 1.6-3.33 for double- and triple-lumen devices, respectively). CONCLUSION: Guidewire exchange of PICCs may be associated with increased risk of thrombosis. As some exchanges may be preventable, consideration of risks and benefits of exchanges in clinical practice is needed. Published by Elsevier Inc.
BACKGROUND: Catheter exchange over a guidewire is frequently performed for malfunctioning peripherally inserted central catheters (PICCs). Whether such exchanges are associated with venous thromboembolism is not known. METHODS: We performed a retrospective cohort study to assess the association between PICC exchange and risk of thromboembolism. Adult hospitalized patients that received a PICC during clinical care at one of 51 hospitals participating in the Michigan Hospital Medicine Safety consortium were included. The primary outcome was hazard of symptomatic venous thromboembolism (radiographically confirmed upper-extremity deep vein thrombosis and pulmonary embolism) in those that underwent PICC exchange vs those that did not. RESULTS: Of 23,010 patients that underwent PICC insertion in the study, 589 patients (2.6%) experienced a PICC exchange. Almost half of all exchanges were performed for catheter dislodgement or occlusion. A total of 480 patients (2.1%) experienced PICC-associated deep vein thrombosis. The incidence of deep vein thrombosis was greater in those that underwent PICC exchange vs those that did not (3.6% vs 2.0%, P < .001). Median time to thrombosis was shorter among those that underwent exchange vs those that did not (5 vs 11 days, P = .02). Following adjustment, PICC exchange was independently associated with twofold greater risk of thrombosis (hazard ratio [HR] 1.98; 95% confidence interval [CI], 1.37-2.85) vs no exchange. The effect size of PICC exchange on thrombosis was second in magnitude to device lumens (HR 2.06; 95% CI, 1.59-2.66 and HR 2.31; 95% CI, 1.6-3.33 for double- and triple-lumen devices, respectively). CONCLUSION: Guidewire exchange of PICCs may be associated with increased risk of thrombosis. As some exchanges may be preventable, consideration of risks and benefits of exchanges in clinical practice is needed. Published by Elsevier Inc.
Entities:
Keywords:
Central venous catheter; Deep vein thrombosis; Exchange; PICC; Peripherally inserted central catheter; Thromboembolism
Authors: Barbara W Trautner; Sanjay Saint; Karen E Fowler; John Van; Tracey Rosen; John Colozzi; Vineet Chopra; Erica Lescinskas; Sarah L Krein Journal: Am J Infect Control Date: 2019-07-16 Impact factor: 2.918
Authors: Valerie M Vaughn; Megan O'Malley; Scott A Flanders; Tejal N Gandhi; Lindsay A Petty; Anurag N Malani; Allison Weinmann; Jennifer K Horowitz; Vineet Chopra Journal: JAMA Netw Open Date: 2020-10-01