NEW YORK (Reuters Health) – The risk of developing symptomatic deep vein thrombosis with a peripherally inserted central catheter (PICC) is associated with the size of the catheter, according to findings from a year-long observational study reported in the October issue of Chest.

“Rates of PICC-associated DVT may be reduced by improved selection of patients and catheter size,” lead author Dr. R. Scott Evans of LDS Hospital in Salt Lake City, Utah, and colleagues conclude.

They note in their report that DVT is a complication of PICC use. Upper-extremity thrombosis may result in symptomatic pulmonary embolism in as many as 9% of cases, and it carries a fatality rate up to 25%.

To investigate risk factors for DVT associated with PICC placement, the team analyzed data on 2014 PICCs performed in 1879 distinct patient hospitalizations. “Most PICCs were placed in the right arm (76.9%) and basilic vein (74%) and were double-lumen 5F (75.3%).” DVT occurred in the cannulated vein or adjacent vein in 60 PICCS in 57 patients.

The team found that DVT risk increased with prior DVT (odds ratio [OR], 9.92, p<0.001). “More importantly,” they report, risk increased with use of double-lumen compared with single-lumen PICC (OR, 7.54; p<0.05), and use of triple-lumen compared with single-lumen PICC (OR, 19.50; p<0.01). “Therefore, we believe that the decision to place a PICC and the number of lumens chosen should be a thoughtful decision based on the specific clinical needs of the patient,” Dr. Evans and colleagues advise. “Catheter size should be based on compelling clinical indications not on convenience or department stock.” The authors point out that there are disadvantages to using smaller sized catheters. They’re more fragile and more likely to kink. Still, they conclude, “Our results suggest that the risk of DVT attributable to larger sized catheters should be considered when deciding how many lumens will be needed. The results of this study suggest that triple-lumen 6F catheters should not be routinely used in the absence of an indication for three lumens.” Reference:
Risk of Symptomatic DVT Associated With Peripherally Inserted Central Catheters

Chest 2010; 138:803-810.