New practice models are in demand for prevention and reduction in rates of catheter thrombosis that can be devastating to the health care system and patients
Risk factors for catheter thrombosis were analyzed retrospectively for their impact
Site of insertion and overall use of anticoagulation at the time of catheter placement did not show any significant impact on incidence of thrombosis
Several variables (i.e., triple lumen, critically ill) were used to create a clinical prediction score model
Background: Benefits of using peripherally inserted central venous catheters (PICCs) have often overshadowed the risk of catheter thrombosis (CT). Quality improvement models should be implemented to reduce this complication rate.
Methods: Incidence rate of CT was the main outcome. Predictors included age, lumen size, major surgery, previous venous thromboembolism, body mass index, catheter infection, thrombophilia, critically-ill and inferior-vena-cava filters/pacemaker/implantable-cardioverter-defibrillator. The contributions of anticoagulation and the catheter insertion site were considered.
Results: Among 1683 subjects, 1560 received PICCs (5.83% CT), and 123 had midlines (4.88% CT). Ninety-two CT cases were compared to 1591 controls. A summated risk score was created using variables from our multivariate logistic model that showed significance as predictors in incidence of thrombosis. The risk score model, divided into 3 tertiles, correctly classified 94.5% of cases and distinguished high-risk patients. No difference between vein insertion sites was noted. The basilic vein was associated with 5.5% CT versus 5.3% with non-basilic vein insertions. Similarly, the brachial vein was associated with 4.8% CT versus 5.6% for nonbrachial vein insertions. Finally, the cephalic vein resulted in 7.6% CT versus 5.4% for non-cephalic vein insertions. When anticoagulation was used at the time of catheter insertion, the incidence rate was 22.8% versus 77.2% when it was not used. No statistical difference was noted, when compared to controls.
Conclusion: Identified risk factors are associated with increased rate of thrombosis. A clinical prediction score can objectively identify high risk patients. Our results suggest no statistical difference in thrombosis event between vein insertion sites or use of prophylactic anticoagulation.