<\/span>Incidence and Risk factors for PICC related DVT<\/span><\/h3>\nThe Michigan Risk Score can be used to assess risk of developing DVT in PICC line placement. <\/span>https:\/\/www.mdcalc.com\/michigan-risk-score-picc-related-thrombosis<\/span><\/a><\/p>\nEven when used for short-term (days) or medium-term (weeks) treatment, PICCs have a higher risk of venous thrombosis compared with centrally inserted catheters. This is especially a concern in patients who are critically ill or who have a malignancy. The incidence of deep vein thrombosis (DVT) for PICCs is between 5 and 15 percent for hospitalized patients and 2 and 5 percent for outpatients. Some studies that were set up to simply screen for even asymptomatic DVTs in patients with PICCs found as high a rate as 33%. When compared with central venous catheters PICC lines have a 2.5 fold greater risk of thrombosis among several studies reviewed.<\/span><\/p>\nOne particular study, the Medical Inpatients and Thrombosis (MITH) Study was a case-cohort study which looked at all venous thromboembolism at a single institution from 2000 to 2009. They found that central venous catheters had a 14fold increased risk of upper extremity DVT but without significantly increased pulmonary embolism<\/a> risk. Other studies have shown that repeat access into the same area further increased risk of DVT.<\/span><\/p>\nRisk factors for forming DVTs from PICC lines include, prior history of DVT, obesity, hematological malignancies, critical illness, and comorbidities such as diabetes and obstructive lung disease have been linked to PICC-related DVT . Additionally catheters with more lumens which are invariably larger tend to have a higher risk of DVT along with catheters placed on the left side or catheters that have been exchanged multiple times.<\/span><\/p>\nThe catheter to the vein diameter ratio affects the risk for thrombosis. When the catheter is less than 45% the diameter of the vessel it traverses the risk of DVT decreases. PICCs that are larger than 45% the diameter of the vessel they cross have a significantly (13X) increased risk of DVT formation. The brachial and basilic veins provide a large cross-sectional area for placing a PICC. 1 study found that triple lumen PICCs were associated with a greater than 58% risk of DVT.<\/span><\/p>\nOther considerations include the importance of proper technique for catheter placement preferably by an interventional radiologist or someone who is well trained in placement of PICC lines. Ultrasound guidance is important in obtaining access and limiting complications. Additionally positioning of the tip of the PICC line is important in limiting complications. PICC tips should be at the cavoatrial junction or in the right atrium where blood flow is rapid and DVT risk is lessened. PICCs malpositioned with the tip in the proximal SVC have a seven fold increased risk of DVT.<\/span><\/p>\nNewer technique for placement of PICCs including using electrocardiographic technology (a device that localizes the PICC tip to the sinoatrial node that resides close to the cavo atrial junction\/right atrium) helps position the tip of the catheter in the right spot even for bedside PICC line placement. <\/span><\/p>\n <\/p>\n