Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study
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Carr, Peter
Childs, Jessie
Scullion, Andrew
Young, Mark
Flynn, Tanya
Kirker, Carolyn
Jackson, Gavin
Esterman, Adrian
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Abstract
Objectives Determine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group. Design Retrospective cohort study. Setting 4 tertiary hospitals in Australia and New Zealand. Participants Adults who had undergone PICC insertion. Primary outcome measure Symptomatic thrombus of the limb in which the PICC was inserted. Results 2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions. Conclusions Adherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.
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BMJ Open
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11
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7
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© Author(s) (or their employer(s)) 2021. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
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Clinical sciences
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Nursing
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Medicine, General & Internal
General & Internal Medicine
radiology & imaging
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Sharp, R; Carr, P; Childs, J; Scullion, A; Young, M; Flynn, T; Kirker, C; Jackson, G; Esterman, A, Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study, BMJ Open, 2021, 11 (7), pp. e045895