Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients
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 deta...
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| Veröffentlicht in: | Intensive care medicine 2012-02, Vol.38 (2), p.272-278 |
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| creator | Wilson, Thomas J. Brown, Devin L. Meurer, William J. Stetler, William R. Wilkinson, D. Andrew Fletcher, Jeffrey J. |
| description | 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. |
| doi_str_mv | 10.1007/s00134-011-2418-7 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_926885285</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A724320574</galeid><sourcerecordid>A724320574</sourcerecordid><originalsourceid>FETCH-LOGICAL-c537t-9f5264d2ad858e88ad0c4512e687a5f12bc24b7a94c210590c5553d7b4651eb73</originalsourceid><addsrcrecordid>eNqFkt2KFDEQhRtR3HH1AbyRRhGvek3SSSdzuSz-wYIgeh3S6eqZrD3JmMrssm_hI1vtjC7KiOQikPpOhTp1quopZ2ecMf0aGeOtbBjnjZDcNPpeteCyFQ0XrblfLVgrRSM7KU6qR4hXROtO8YfViRCct4abRfX9U8Cv9eh8SRlrh5h8cAWG-iaUdb2FHLZryG6abusQEfJc8hALPdXXENMOa-_KGgrkJsP0Uzq5vAKqhliXdU6bPmFAktcRdjlNaRU8qUMsEDFcAzXIUG9dCdQXH1cPRjchPDncp9WXt28-X7xvLj---3Bxftl41erSLEclOjkINxhlwBg3MC8VF9AZ7dTIRe-F7LVbSi84U0vmlVLtoHtJDkCv29Pq1b7vNqdvO8BiNwE9TJOLQFPZpeiMUcKo_5NcG6V4x4l8_hd5lXY50hgz1AqlGCPoxR5auQlsiGMiM_3c0p5rQdtjSkuimiPUCuK8jBRhDPT8B392hKczwCb4owK-F_icEDOMdpvDxuVby5md02X36bKULjuny86ePTvMt-s3MPxW_IoTAS8PgEPa8Zhd9AHvOKW6TrRL4sSeQyrFFeQ7o_79-w_oL-ce</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>917325500</pqid></control><display><type>article</type><title>Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Wilson, Thomas J. ; Brown, Devin L. ; Meurer, William J. ; Stetler, William R. ; Wilkinson, D. Andrew ; Fletcher, Jeffrey J.</creator><creatorcontrib>Wilson, Thomas J. ; Brown, Devin L. ; Meurer, William J. ; Stetler, William R. ; Wilkinson, D. Andrew ; Fletcher, Jeffrey J.</creatorcontrib><description>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.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-011-2418-7</identifier><identifier>PMID: 22113818</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthesiology ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Catheterization ; Catheters ; Cohort analysis ; Cohort Studies ; Complications ; Critical Care ; Critical Care Medicine ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Emergency Medicine ; Female ; Historical account ; Hospitals ; Humans ; Intensive ; Intensive care ; Intensive care medicine ; Intensive care units ; Male ; medical instruments ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Nervous System Diseases - therapy ; Original ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Retrospective Studies ; Reviews ; Risk Factors ; Surgery ; Thromboembolism ; Thrombosis ; Ultrasonic imaging ; Upper Extremity Deep Vein Thrombosis - epidemiology ; Veins & arteries ; Venous access</subject><ispartof>Intensive care medicine, 2012-02, Vol.38 (2), p.272-278</ispartof><rights>Copyright jointly held by Springer and ESICM 2011</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2012 Springer</rights><rights>Copyright jointly held by Springer and ESICM 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c537t-9f5264d2ad858e88ad0c4512e687a5f12bc24b7a94c210590c5553d7b4651eb73</citedby><cites>FETCH-LOGICAL-c537t-9f5264d2ad858e88ad0c4512e687a5f12bc24b7a94c210590c5553d7b4651eb73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-011-2418-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-011-2418-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25566239$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22113818$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wilson, Thomas J.</creatorcontrib><creatorcontrib>Brown, Devin L.</creatorcontrib><creatorcontrib>Meurer, William J.</creatorcontrib><creatorcontrib>Stetler, William R.</creatorcontrib><creatorcontrib>Wilkinson, D. Andrew</creatorcontrib><creatorcontrib>Fletcher, Jeffrey J.</creatorcontrib><title>Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>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.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthesiology</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Catheterization</subject><subject>Catheters</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Complications</subject><subject>Critical Care</subject><subject>Critical Care Medicine</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Historical account</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Intensive care units</subject><subject>Male</subject><subject>medical instruments</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nervous System Diseases - therapy</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Retrospective Studies</subject><subject>Reviews</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><subject>Ultrasonic imaging</subject><subject>Upper Extremity Deep Vein Thrombosis - epidemiology</subject><subject>Veins & arteries</subject><subject>Venous access</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkt2KFDEQhRtR3HH1AbyRRhGvek3SSSdzuSz-wYIgeh3S6eqZrD3JmMrssm_hI1vtjC7KiOQikPpOhTp1quopZ2ecMf0aGeOtbBjnjZDcNPpeteCyFQ0XrblfLVgrRSM7KU6qR4hXROtO8YfViRCct4abRfX9U8Cv9eh8SRlrh5h8cAWG-iaUdb2FHLZryG6abusQEfJc8hALPdXXENMOa-_KGgrkJsP0Uzq5vAKqhliXdU6bPmFAktcRdjlNaRU8qUMsEDFcAzXIUG9dCdQXH1cPRjchPDncp9WXt28-X7xvLj---3Bxftl41erSLEclOjkINxhlwBg3MC8VF9AZ7dTIRe-F7LVbSi84U0vmlVLtoHtJDkCv29Pq1b7vNqdvO8BiNwE9TJOLQFPZpeiMUcKo_5NcG6V4x4l8_hd5lXY50hgz1AqlGCPoxR5auQlsiGMiM_3c0p5rQdtjSkuimiPUCuK8jBRhDPT8B392hKczwCb4owK-F_icEDOMdpvDxuVby5md02X36bKULjuny86ePTvMt-s3MPxW_IoTAS8PgEPa8Zhd9AHvOKW6TrRL4sSeQyrFFeQ7o_79-w_oL-ce</recordid><startdate>20120201</startdate><enddate>20120201</enddate><creator>Wilson, Thomas J.</creator><creator>Brown, Devin L.</creator><creator>Meurer, William J.</creator><creator>Stetler, William R.</creator><creator>Wilkinson, D. Andrew</creator><creator>Fletcher, Jeffrey J.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7T2</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>20120201</creationdate><title>Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients</title><author>Wilson, Thomas J. ; Brown, Devin L. ; Meurer, William J. ; Stetler, William R. ; Wilkinson, D. Andrew ; Fletcher, Jeffrey J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c537t-9f5264d2ad858e88ad0c4512e687a5f12bc24b7a94c210590c5553d7b4651eb73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthesiology</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Catheterization</topic><topic>Catheters</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Complications</topic><topic>Critical Care</topic><topic>Critical Care Medicine</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Historical account</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Intensive care units</topic><topic>Male</topic><topic>medical instruments</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nervous System Diseases - therapy</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Retrospective Studies</topic><topic>Reviews</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Thromboembolism</topic><topic>Thrombosis</topic><topic>Ultrasonic imaging</topic><topic>Upper Extremity Deep Vein Thrombosis - epidemiology</topic><topic>Veins & arteries</topic><topic>Venous access</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wilson, Thomas J.</creatorcontrib><creatorcontrib>Brown, Devin L.</creatorcontrib><creatorcontrib>Meurer, William J.</creatorcontrib><creatorcontrib>Stetler, William R.</creatorcontrib><creatorcontrib>Wilkinson, D. Andrew</creatorcontrib><creatorcontrib>Fletcher, Jeffrey J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wilson, Thomas J.</au><au>Brown, Devin L.</au><au>Meurer, William J.</au><au>Stetler, William R.</au><au>Wilkinson, D. Andrew</au><au>Fletcher, Jeffrey J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2012-02-01</date><risdate>2012</risdate><volume>38</volume><issue>2</issue><spage>272</spage><epage>278</epage><pages>272-278</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22113818</pmid><doi>10.1007/s00134-011-2418-7</doi><tpages>7</tpages></addata></record> |
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| ispartof | Intensive care medicine, 2012-02, Vol.38 (2), p.272-278 |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthesiology Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Catheterization Catheters Cohort analysis Cohort Studies Complications Critical Care Critical Care Medicine Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Emergency Medicine Female Historical account Hospitals Humans Intensive Intensive care Intensive care medicine Intensive care units Male medical instruments Medical sciences Medicine Medicine & Public Health Middle Aged Nervous System Diseases - therapy Original Pain Medicine Patients Pediatrics Pneumology/Respiratory System Retrospective Studies Reviews Risk Factors Surgery Thromboembolism Thrombosis Ultrasonic imaging Upper Extremity Deep Vein Thrombosis - epidemiology Veins & arteries Venous access |
| title | Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients |
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