Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods - 04/02/21
Abstract |
Background |
Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown.
Methods |
Prospectively collected data from patients that received peripherally inserted central catheters at 52 Michigan hospitals were analyzed. The method used to confirm tip confirmation at insertion and deep vein thrombosis outcomes were extracted from medical records. Multivariate models (accounting for the clustered nature of the data) were fitted to assess the association between peripherally inserted central catheter-related deep vein thrombosis and method of tip confirmation (electrocardiographic vs radiographic imaging).
Results |
A total of 42,687 peripherally inserted central catheters (21,098 radiology vs 21,589 electrocardiographic) were included. Patients receiving electrocardiographic-confirmed peripherally inserted central catheters had fewer comorbidities compared with those that underwent placement via radiology. Overall, deep vein thrombosis occurred in 594 (1.3%) of all peripherally inserted central catheters. Larger catheter size (odds radio [OR] 1.32; 95% confidence interval [CI], 0.93-1.90 per unit increase in gauge), history of deep vein thrombosis, and cancer were associated with increased risk of deep vein thrombosis (OR 2.00; 95% CI, 1.65-2.43 and OR 1.62; 95% CI, 1.16-2.26, respectively) using logistic regression. Following adjustment, electrocardiographic guidance was associated with a significant reduction in peripherally inserted central catheter-related deep vein thrombosis compared with radiographic imaging (OR 0.74; 95% CI, 0.58-0.93; P = .0098).
Conclusion |
The use of electrocardiography to confirm peripherally inserted central catheter tip placement at the cavoatrial junction was associated with significantly fewer deep vein thrombosis events than radiographic imaging. Use of this approach for peripherally inserted central catheter insertion may help improve patient safety, particularly in high-risk patients.
Le texte complet de cet article est disponible en PDF.Keywords : Catheter, Electrocardiography, Peripherally inserted central catheter, Venous thromboembolism
Plan
| Funding: This project was supported by funding from Blue Cross/Blue Shield of Michigan / Blue Care Network for the Hospital Medicine Safety Collaborative. |
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| Conflict of Interest: TK reports investigator-initiated research grants and speaker fees provided to Griffith University from vascular access product manufacturers 3M Medical, Access Scientific, BD-Bard, Baxter; Cardinal Health, unrelated to the current project. CMR reports that Griffith University has received unrestricted investigator-initiated research or educational grants on her behalf from product manufacturers (BD-Bard; Cardinal Health), and Griffith University has received consultancy payments on her behalf from manufacturers (3M, BBraun, BD-Bard); AJU reports investigator-initiated research grants and speaker fees provided to Griffith University from vascular access product manufacturers (3M Medical, Becton Dickinson, Cardinal Health), unrelated to the current project; NM's former employer (Griffith University) has received, on her behalf, from manufacturers of vascular access device products: investigator-initiated research grants and unrestricted educational grants from Becton Dickinson and Cardinal Health, and a consultancy payment from Becton Dickinson; JS reports that Griffith University has received unrestricted investigator-initiated research or educational grants on her behalf from product manufacturers BD-Bard; VC has received grant support from the Agency for Healthcare Research and Quality and the American Hospital Association. He has also received royalties from Wolters Kluwer Health and Oxford University Press related to books he has authored. The other authors have indicated they have no financial relationships relevant to this article to disclose. |
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| Authorship: All authors had access to the data and played a role in writing the manuscript. |
Vol 134 - N° 2
P. e79-e88 - février 2021 Retour au numéro
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