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Peripherally Inserted Central Catheter-associated Deep Vein Thrombosis: A Narrative Review

  • Nabil Fallouh
    Affiliations
    Department of General Medicine, University of Michigan Health System, Ann Arbor
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  • Helen M. McGuirk
    Affiliations
    Department of General Medicine, University of Michigan Health System, Ann Arbor

    Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and the Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Mich
    Search for articles by this author
  • Scott A. Flanders
    Affiliations
    Department of General Medicine, University of Michigan Health System, Ann Arbor
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  • Vineet Chopra
    Correspondence
    Requests for reprints should be addressed to Vineet Chopra, MD, MSc, Department of General Medicine, University of Michigan Health System, 2800 Plymouth Road, Building 16, Rm 432W, Ann Arbor, MI 48109.
    Affiliations
    Department of General Medicine, University of Michigan Health System, Ann Arbor

    Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and the Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Mich
    Search for articles by this author
Published:February 16, 2015DOI:https://doi.org/10.1016/j.amjmed.2015.01.027

      Abstract

      Background

      Although common, little is known about factors associated with peripherally inserted central catheter-related deep vein thrombosis (PICC-DVT). To better guide clinicians, we performed a comprehensive literature review to summarize best practices for this condition.

      Methods

      A systematic search of the literature for studies reporting epidemiology, diagnosis, treatment, and prevention of PICC-DVT was conducted. Algorithms for diagnosis and management were compiled using available evidence.

      Results

      The incidence of PICC-DVT varied between 2% and 75% according to study population, testing modality and threshold for diagnosis. Studies evaluating the diagnostic utility of clinical symptoms suggested that these were neither sensitive nor specific for PICC-DVT; conversely, ultrasonography had excellent sensitivity and specificity and is recommended as the initial diagnostic test. Although more specific, contrast venography should be reserved for cases with high clinical probability and negative ultrasound findings. Centrally positioned, otherwise functional and clinically necessary PICCs need not be removed despite concomitant DVT. Anticoagulation with low-molecular-weight heparin or warfarin for at least 3 months represents the mainstay of treatment. The role of pharmacologic prophylaxis and screening for PICC-DVT in the absence of clinical symptoms is unclear at this time.

      Conclusions

      PICC-DVT is common, costly and morbid. Available evidence provides guidance for diagnosis, treatment and prevention of this condition.

      Keywords

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