PICCs Increase Thromboembolism Risk

Recent years have seen a marked increase in the use of peripherally inserted intravenous catheters (PICCs). Because these catheters terminate in the central veins, they can be used to infuse antibiotics, deliver chemotherapy, and monitor hemodynamics; in addition, they lack the potential complications associated with placement of central venous catheters. They come with their own complications, however, including upper-extremity deep venous thrombosis (DVT) and pulmonary embolism (PE). The extent of such risk is unknown, as is whether PICCs are associated with lower-extremity DVT.

To explore this issue, researchers analyzed data on medical patients who were hospitalized between January 2011 and March 2014 at any of 48 Michigan facilities. Of these 76,242 patients, 3790 were identified as having a PICC present at the time of hospital admission or placed during that stay. A total of 876 thromboembolic events occurred in 774 patients. Overall, having a PICC was associated with a significant risk for upper-extremity DVT (P<0.001), lower-extremity DVT (P=0.002), and PE (P=0.024). After adjustment for other risk factors including hospitalization during the preceding year, diagnosis of cancer during the preceding year, and history of venous thromboembolism, PICC use was independently associated with upper-extremity DVT (hazard ratio, 10.49; P<0.001) and with lower-extremity DVT (HR, 1.48; P=0.04) but not with PE (HR, 1.34; P=0.19).