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Nursing
Original research
Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study
  1. Rebecca Sharp1,
  2. Peter Carr2,3,
  3. Jessie Childs4,
  4. Andrew Scullion5,
  5. Mark Young6,
  6. Tanya Flynn7,
  7. Carolyn Kirker8,
  8. Gavin Jackson9,
  9. Adrian Esterman1
  1. 1Clinical and Health Sciences/Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
  2. 2School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
  3. 3Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Nathan, Queensland, Australia
  4. 4Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
  5. 5Vascular Access Team, Calvary Mater Hospital, Newcastle, New South Wales, Australia
  6. 6Peri-Operative Services, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
  7. 7Cancer Services, St George Hospital, Sydney, New South Wales, Australia
  8. 8Department of Anaesthesia and Pain Management, Capital and Coast District Health Board, Wellington, New Zealand
  9. 9Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Rebecca Sharp; Rebecca.Sharp{at}unisa.edu.au

Abstract

Objectives Determine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group.

Design Retrospective cohort study.

Setting 4 tertiary hospitals in Australia and New Zealand.

Participants Adults who had undergone PICC insertion.

Primary outcome measure Symptomatic thrombus of the limb in which the PICC was inserted.

Results 2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions.

Conclusions Adherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.

  • radiology & imaging
  • interventional radiology
  • adult oncology

Data availability statement

Data are available on reasonable request from the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-045895

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    Data availability statement

    Data are available on reasonable request from the corresponding author.

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    Footnotes

    • Contributors RS: contributions to conception and design, literature search, data analysis and interpretation, writing, final approval of the version to be published. PC and GJ: contributions to conception and design, data interpretation, writing, final approval of the version to be published. AS, MY, TF, CK: contributions to conception and design, acquisition of data, data interpretation, writing, final approval of the version to be published. AE, JC: contributions to conception and design, data analysis and interpretation, writing, final approval of the version to be published.

    • Funding This work was supported by a Pathfinder grant from the University of South Australia, Adelaide, Australia (School of Nursing and Midwifery). Award/grant number is not applicable. There was no conflict of interest, activities or potential for influencing this work by the funders.

    • Disclaimer The grant organisation had no financial interest or role in the design, conduct, analysis or manuscript preparation for this project.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.