The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study.

Sharp, Rebecca, Cummings, Melita, Fielder, Andrea, Mikocka-Walus, Antonina, Grech, Carol and Esterman, Adrian 2015, The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study., International journal of nursing studies, vol. 52, no. 3, pp. 677-685, doi: 10.1016/j.ijnurstu.2014.12.002.

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Title The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study.
Author(s) Sharp, Rebecca
Cummings, Melita
Fielder, Andrea
Mikocka-Walus, AntoninaORCID iD for Mikocka-Walus, Antonina orcid.org/0000-0003-4864-3956
Grech, Carol
Esterman, Adrian
Journal name International journal of nursing studies
Volume number 52
Issue number 3
Start page 677
End page 685
Total pages 9
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2015-03
ISSN 1873-491X
Keyword(s) Nursing
Peripherally inserted central catheter
Ultrasonography
Venous thromboembolism
Summary BACKGROUND: Peripherally inserted central catheters (PICCs) are a common vascular access device used in clinical practice. Their use may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice. OBJECTIVES: To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event. METHOD: Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited between May and December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE. RESULTS: Data were available for 136 patients (50% cancer; 44% infection; 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761; 95% CI 0.681-0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022; CI 1.445-122.788). CONCLUSION: It was found that a 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research is needed to confirm these results as although adequately powered; the number of cases of VTE was comparatively small, resulting in wide confidence intervals.
Language eng
DOI 10.1016/j.ijnurstu.2014.12.002
Field of Research 111099 Nursing not elsewhere classified
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, Elsevier
Persistent URL http://hdl.handle.net/10536/DRO/DU:30088643

Document type: Journal Article
Collection: School of Psychology
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