Guidewire exchange of PICCs associated with higher risk of thrombosis

Reference

Chopra V, Kaatz S, Grant P, et al. Risk of venous thromboembolism following peripherally inserted central catheter exchange: an analysis of 23,000 hospitalized patients. Am J Med 2018;131(6):651-660.

Synopsis

Using medical record data from 51 hospitals in Michigan, these investigators evaluated the risk of thrombosis associated with a guidewire exchange of malfunctioning PICCs. Adult patients hospitalized in a general medicine ward or intensive care unit who received a PICC for any reason were eligible and were followed up until PICC removal, death, or for 70 days, whichever came first. The primary outcome was acute pulmonary embolism or acute symptomatic upper extremity deep vein thrombosis that occurred after initial PICC placement or after PICC exchange. Overall, 589 of the 23,010 patients included in the analysis underwent a PICC exchange with approximately half due to catheter dislodgment and occlusion. Patients who had PICC exchanges were more likely to have a higher prevalence of severe liver disease, active cancer, a recent history of deep vein thrombosis, and a history of central line–associated bloodstream infection; were more likely to have had a prior central venous catheter or an existing central venous catheter at the time of exchange; and more often had double-lumen or triple-lumen PICCs. Ultimately, patients who underwent a PICC exchange had a higher risk of venous thromboembolism than those who did not have an exchange (3.6% vs 2.0%; P < .001). After adjusting for patient, provider, and device factors, PICC exchange was still associated with a higher risk of thrombosis (hazard ratio 1.98; 95% CI 1.37 - 2.85), second only to the presence of multiple-lumen PICCs.