Darren White1, Scott C Woller2, Scott M Stevens2, Dave S Collingridge3, Vineet Chopra4, Gabriel V Fontaine5. 1. Intermountain Medical Center, Department of Internal Medicine, Murray, UT, United States of America. Electronic address: darren.white@imail.org. 2. Intermountain Medical Center, Department of Internal Medicine, Murray, UT, United States of America; University of Utah Division of General Internal Medicine, Department of Internal Medicine, Salt Lake City, UT, United States of America. 3. Intermountain Medical Center, Office of Research, Murray, UT, United States of America. 4. Division of Hospital Medicine, Department of Medicine, Michigan Medicine, Ann Arbor, MI, United States of America. 5. Intermountain Medical Center, Department of Pharmacy Murray, UT, United States of America; Intermountain Healthcare, Neurosciences Institute, Salt Lake City, UT, United States of America; University of Utah, College of Pharmacy, Salt Lake City, UT, United States of America; Roseman University, College of Pharmacy, South Jordan, UT, United States of America.
Abstract
BACKGROUND: Central venous catheters (CVC) and peripherally inserted central catheters (PICCs) are central vascular access devices (CVADs) that facilitate administration of medications among critically ill patients. Both are associated with risk of venous thromboembolism (VTE). The relative risk of VTE between these catheter types is not well defined. We report the rate of VTE in intensive care unit (ICU) medical patients receiving PICC, CVC, both, or neither. METHODS: We conducted a single-center, retrospective cohort study of medical-ICU patients between November 2007 and November 2013 grouped by receipt of CVC, PICC, both, or neither. The primary outcome was the rate of 30-day symptomatic venous thrombosis (upper and lower deep vein thrombosis and pulmonary embolism). Cox modeling was used to analyze this population and adjust for comorbidities which could contribute to VTE. Secondary outcomes included VTE location, major bleeding, and all-cause mortality among patients with and without CVADs. RESULTS: We analyzed 5788 patients. CVADs were placed in 2403 (42%) patients (PICC, n = 816; CVC, n = 1153; both, n = 434). Compared with no CVAD, the hazard ratio (HR) for 30-day VTE was 1.81 (95% CI 1.52-2.17) for any CVAD, 1.90 (95% CI 1.52-2.37) for PICC, 1.57 (95% CI 1.26-1.96) for CVC, and 2.70 (95% CI 2.09-3.47) for both. PICCs had a non-significantly higher HR for VTE compared with CVC (1.21; 95% CI 0.94-1.55). For patients with both a CVC and PICC the HR for VTE was 1.72 times that of solitary CVAD (95% CI 1.32-2.23). CONCLUSIONS: Among critically ill medical patients, PICCs and CVCs were associated with increased risk of VTE. Placement of both conferred higher risk of VTE compared with either alone.
BACKGROUND: Central venous catheters (CVC) and peripherally inserted central catheters (PICCs) are central vascular access devices (CVADs) that facilitate administration of medications among critically ill patients. Both are associated with risk of venous thromboembolism (VTE). The relative risk of VTE between these catheter types is not well defined. We report the rate of VTE in intensive care unit (ICU) medical patients receiving PICC, CVC, both, or neither. METHODS: We conducted a single-center, retrospective cohort study of medical-ICU patients between November 2007 and November 2013 grouped by receipt of CVC, PICC, both, or neither. The primary outcome was the rate of 30-day symptomatic venous thrombosis (upper and lower deep vein thrombosis and pulmonary embolism). Cox modeling was used to analyze this population and adjust for comorbidities which could contribute to VTE. Secondary outcomes included VTE location, major bleeding, and all-cause mortality among patients with and without CVADs. RESULTS: We analyzed 5788 patients. CVADs were placed in 2403 (42%) patients (PICC, n = 816; CVC, n = 1153; both, n = 434). Compared with no CVAD, the hazard ratio (HR) for 30-day VTE was 1.81 (95% CI 1.52-2.17) for any CVAD, 1.90 (95% CI 1.52-2.37) for PICC, 1.57 (95% CI 1.26-1.96) for CVC, and 2.70 (95% CI 2.09-3.47) for both. PICCs had a non-significantly higher HR for VTE compared with CVC (1.21; 95% CI 0.94-1.55). For patients with both a CVC and PICC the HR for VTE was 1.72 times that of solitary CVAD (95% CI 1.32-2.23). CONCLUSIONS: Among critically ill medical patients, PICCs and CVCs were associated with increased risk of VTE. Placement of both conferred higher risk of VTE compared with either alone.
Authors: Scott C Woller; Scott M Stevens; Stacy A Johnson; Joseph R Bledsoe; Brian Galovic; James F Lloyd; Emily L Wilson; Brent Armbruster; R Scott Evans Journal: Res Pract Thromb Haemost Date: 2019-05-13