Clinical problems associated with the use of peripheral venous approaches in clinical practice: Thrombosis

Abstract

The widespread diffusion of PICCs has led to an increase of catheter-related thrombosis; in fact, PICC-related DVT (deep vein thrombosis) appears to be more frequent than CVC-related DVT and presents some peculiar characteristics; nevertheless, they seem to be less dangerous than other upper limbo DVT (pulmonary embolism rarely reported) and easier to diagnose.PRDVT can be more or less symptomatic with a variety of manifestations; diagnostic procedure is easy to perform for trained physicians or nurses working in a PICC team with an ultrasound device. Risk factors are still to be fully investigated. For what concerns treatment, recent guidelines (ACCP, SOR, GAVeCeLT) do not recommend to remove the catheter if functional and not infected (except in case of pulmonary embolism); anticoagulation must be performed as long as the catheter is maintained or at least 3 months after removal.Pharmacological prophylaxis has not proven to be effective. The only possible prevention is the adherence to protocols (“bundles”) aiming to avoid all known risk factors (infection, excessive blood flow reduction, endothelial damage, known hypercoagulability).