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Rebecca Sharp, BN, BHSc (Hons)

PhD candidate, University of South Australia, Adelaide, Australia

presenter photoRebecca Sharp is a Registered Nurse at a major metropolitan hospital in Adelaide Australia. She is also a PhD candidate in the School of Nursing and Midwifery at the University of South Australia. Rebecca's PhD project centres on vein choice for Peripherally Inserted Central Catheter (PICC) insertion to reduce the risk of VTE (venous thromboembolism).

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Risk Reduction Track

F101 – Oral Abstract Presentations (F101)

Vein Occupancy Ratio and Rates of Venous Thromboembolism in patients with a PICC

calendar9/8/2014

clock2:15 PM - 2:30 PM

clockRoom: Potomac 1-2

CE Hours: 1.2 per four (4) 15-minute sessions


Rebecca Sharp, BN, BHSc (Hons)

PhD candidate, University of South Australia, Adelaide, Australia

Purpose/Design: The occupancy ratio (proportion of the vein taken up by the catheter) is thought to be a controllable factor in the reduction of venous thromboembolism (VTE) rates in patients who have a peripherally inserted central catheter (PICC). Some clinicians recommend that no more than 30-50% of the vein be occupied by the catheter. However there is a lack of published literature to support these recommendations and there is a need for evidence to guide practice. Method: Adult patients at a large metropolitan teaching hospital referred for PICC insertion were recruited May 2013-December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they had developed a catheter-related symptomatic thrombus. Results: Data were available for 136 patients (50% cancer; 44% infection; 6% other). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% occupancy ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761; 95% CI 0.681- 0.830). When an occupancy ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalized linear model it was found that participants with an occupancy >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022; CI 1.445-122.788). Limitations: Although adequately powered, the number of cases of VTE was comparatively small. Conclusion: This study suggests that vein occupancy ratio should not exceed 45%. Vein measurement using ultrasound is necessary to ensure an adequate sized vein is identified for PICC insertion to reduce the risk of thrombus.

Learning Objectives:

  • Describe risk factors for PICC associated venous thromboembolism.
  • Understand the importance of vein measurement for PICC insertion.
  • Identify a safe vein occupancy ratio to use in clinical practice to reduce the risk of venous thromboembolism.

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