PICC-DVT: A Narrative Review

Fallouh N, McGuirk HM, Flanders SA, Chopra V.
Peripherally Inserted Central Catheter-Associated Deep Vein Thrombosis: A Narrative Review. Am J Med 2015;128:722-738.

The following are 10 key points from this systematic review of peripherally inserted central catheter-related deep vein thrombosis (PICC-DVT):

  1. The incidence of PICC-DVT varies between 2% and 75%, depending on the study population, testing modality, and threshold for diagnosis. The incidence is higher in critically ill, cancer, and hospitalized patients (5-15%). The incidence among ambulatory patients is lower (2-5%). A recent screening study identified PICC-DVT in 75% of devices, but the majority were asymptomatic.
  2. Risk factors for PICC-DVT include patient factors, provider factors, and device factors. Important predictors among these three groups are prior venous thrombosis, critical illness, malignancy, placement of the PICC tip outside of the superior vena cava, placement in a smaller vein, and greater number of lumens or larger overall PICC gauge.
  3. Although less frequent than embolization from the deep veins of the legs, PICC-associated pulmonary embolism is more common in critically ill and cancer patients.
  4. Clinical symptoms are not sufficiently sensitive or specific for diagnostic utility of PICC-DVT. No existing clinical risk prediction tool is sufficient for diagnosis of PICC-DVT.
  5. Ultrasonography has excellent sensitivity and specificity for diagnosis of PICC-DVT. Therefore, it is recommended as the initial diagnostic test.
  6. Contrast venography can be used for diagnosis in cases of high clinical suspicion when the initial ultrasound testing is negative or inconclusive.
  7. When a PICC-DVT occurs, the PICC can remain in place if functional and clinically necessary.
  8. Anticoagulation with low molecular weight heparin or warfarin for a minimum of 3 months is the mainstay of treatment for PICC-DVT. This is despite any randomized controlled trials specific to PICC-DVT treatment.
  9. Per clinical guidelines, thrombolysis for PICC-DVT should be reserved for patients with severe symptoms (e.g., phlegmasia or functional impairment of the limb), extensive thrombus burden, and low risk of bleeding.
  10. The role of pharmacologic prophylaxis of and screening for PICC-DVT without clinical symptoms is unclear.

Clinical Topics: Anticoagulation Management, Noninvasive Imaging, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Anticoagulants, Diagnostic Imaging, Heparin, Low-Molecular-Weight, Neoplasms, Peripheral Vascular Diseases, Phlebography, Primary Prevention, Pulmonary Embolism, Risk Factors, Ultrasonography, Vena Cava, Superior, Venous Thrombosis, Warfarin

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