Peripherally inserted central catheters ( PICCs ) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters ( CVCs ) is unknown.
Researchers did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs.
Of the 533 citations identified, 64 studies ( 12 with a comparison group and 52 without ) including 29503 patients met the eligibility criteria. In the non-comparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill ( 13.91% ) and those with cancer ( 6.67% ).
The meta-analysis of 11 studies comparing the risk of deep vein thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of deep vein thrombosis ( odds ratio, OR=2.55; p less than 0.0001 ) but not pulmonary embolism ( no events ).
With the baseline PICC-related deep vein thrombosis rate of 2.7% and pooled OR of 2.55, the number needed to harm relative to CVCs was 26.
In conclusion, peripherally inserted central catheters are associated with a higher risk of deep vein thrombosis than are central venous catheters, especially in patients who are critically ill or those with a malignancy.
The decision to insert peripherally inserted central catheters should be guided by weighing of the risk of thrombosis against the benefit provided by these devices. ( Xagena )
Chopra V et al, The Lancet 2013; 382: 311-325