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Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients

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Abstract

Purpose

Using Virchow’s triad as a framework, we sought to identify risk factors independently associated with symptomatic peripherally inserted central venous catheter (PICC)-related large vein thrombosis (PRLVT) in neurological intensive care patients.

Methods

A retrospective cohort study and detailed chart review were performed for 431 consecutive PICCs placed in patients admitted to our neurological intensive care unit between March 2008 and February 2010. Variables theorized to potentially increase the risk of PRLVT were abstracted from the medical record. Each variable was then tested for its independent association with PRLVT.

Results

During the study period, 431 PICCs were placed with an incidence rate for symptomatic thrombosis of 8.4%. In adjusted analysis, catheter placement in a paretic arm (OR, 9.85; 95% CI, 4.42–21.95), surgery longer than 1 h during dwell time of the catheter (OR, 3.26; 95% CI, 1.48–7.17), a history of venous thromboembolism (OR, 6.66; 95% CI, 2.38–18.62), and mannitol use (OR, 3.27; 95% CI 1.27–8.43) were independently associated with the development of thrombosis.

Conclusions

Alterations in blood flow and consistency, but not vessel injury, appear associated with symptomatic thrombosis following placement of PICCs in neurological intensive care patients. Mannitol use and placement in a paretic arm are potentially modifiable risk factors. Given the high incidence rate of symptomatic thrombosis, future studies should focus on comparing cumulative complications of centrally inserted venous catheters and PICCs in intensive care patients.

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Conflict of interest

The authors have no conflicts of interest or financial disclosures to declare.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Room 3552 TC, 48109-5338, Ann Arbor, MI, USA

    Thomas J. Wilson, William R. Stetler Jr., D. Andrew Wilkinson & Jeffrey J. Fletcher

  2. Department of Neurology, University of Michigan, Ann Arbor, MI, USA

    Devin L. Brown

  3. Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA

    William J. Meurer

Authors
  1. Thomas J. Wilson
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  2. Devin L. Brown
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  3. William J. Meurer
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  4. William R. Stetler Jr.
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  5. D. Andrew Wilkinson
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  6. Jeffrey J. Fletcher
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Corresponding author

Correspondence to Jeffrey J. Fletcher.

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Wilson, T.J., Brown, D.L., Meurer, W.J. et al. Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients. Intensive Care Med 38, 272–278 (2012). https://doi.org/10.1007/s00134-011-2418-7

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  • DOI: https://doi.org/10.1007/s00134-011-2418-7

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