PICC Use Increases Risk of Dangerous Blood Clots

A new study suggests that peripherally inserted central catheters (PICCs) more than double the risk of venous thromboembolism (VT) when compared to other central venous catheters (CVCs).

Researchers at the University of Michigan Health System (Ann Arbor, USA) conducted a search of Medline, Embase, Biosis, the Cochrane Central Register of Controlled Trials, Conference Papers Index, and other human studies published in full text, abstract, or poster form. All studies were of adult patients aged at least 18 years who underwent insertion of a PICC; in studies without a comparison group, the pooled frequency of VT was calculated for patients receiving PICCs. In studies comparing PICCs with other CVCs, summary odds ratios (ORs) were calculated with a random effects meta-analysis.

The results showed that of the 533 citations identified, 64 studies (12 with a comparison group and 52 without) including 29,503 patients met the eligibility criteria. In the noncomparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill and those with cancer. A meta-analysis of 11 studies comparing the risk of deep vein VT related to PICCs, with that related to CVCs, showed that PICCs were associated with an increased risk of deep vein thrombosis (OR 2.55), but not pulmonary embolism (PE). The study was published early online on May 20, 2013, in the Lancet.

“Peripherally inserted central catheters have ushered in a new era of care and certainly the benefits of these devices are significant. We’ve gravitated towards using this device over central venous catheters for good reasons, and it may still be the best choice for some people,” said lead author Vineet Chopra, MD, an assistant professor of internal medicine. “Our findings suggest that patients and physicians should carefully review the risks and benefits when it comes to placing PICCs, especially with respect to blood clots. There is no one-size-fits-all approach when considering use of these devices.”

PICCs have become the preferred device through which to administer long-term intravenous (IV) fluids, antibiotics, and other drugs because they have lower risks of infection, they can be conveniently placed at the bedside, and can stay in place for long periods. PICCs are also safer to insert, typically placed in the arm, while CVCs are placed into a large vein in the neck, chest, or groin and risk damage to nerves or arteries. The ability to keep PICCs in for weeks or even months also allows patients who need a constant flow of medications to go home with these catheters.

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