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HMS PICC Tier II DVT Toolkit

The PICC DVT Tier II toolkit steps focus on the life-cycle of the catheter: appropriate insertion and tip verification, appropriate diagnostic testing, technology-based solutions and line necessity evaluations. For each of these elements, specific guidance and recommendations will be provided.

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  5. Step 6: Appropriate Testing for DVT

Step 6: Appropriate Testing for DVT

Key institutional partners to engage in this step: Providers

Elements:
  • Testing for PICC DVT should only be performed in the setting of patient symptoms
    • Screening for DVT in asymptomatic patients is not recommended as the utility is not clear
  • Use compression ultrasonography to examine arm veins for thrombosis
  • Avoid routine “4-limb” screens in patients with fever
  • Consider CT Angiography for chest/central thrombosis
    • CT Venography is the gold standard for diagnosing catheter-related deep vein thrombosis
Resources/Tools
Articles/References

Chopra, V et al. Risk of Venous Thromboembolism Associated with Peripherally Inserted Central Catheters: A Systematic Review and Meta-Analysis. LANCET 2013

  • PICCs are associated with a higher risk of deep vein thrombosis than CVCs, especially in patients who are critically ill or those with a malignancy. The decision to insert PICCs should be guided by weighing the risk of thrombosis against the benefit provided by these devices.

Evans, RS et al. Risk of Symptomatic DVT Associated with Peripherally Inserted Central Catheters. CHEST 2010

  • This article examines risk factors for PICC-associated DVT. They concluded that prior DVT and surgery lasting >1 hour put  patients at increased risk for PICC-associated DVT. Increasing catheter size is also associated with increased risk.

Evans, RS et al. Reduction of Peripherally Inserted Central Catheter-Associated DVT. CHEST 2013

  • Reduction in PICC-associated DVT can be impacted by increased insertion education and training, persistent DVT surveillance and reporting, and judicious PICC diameter selection.

Kearon, C et al. Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012

  • This article provides a detailed summary of the evidence-based medicine recommendations for avoiding and treating thrombosis.