Gordon McLennan MD, Presenter: Data Safety Monitoring Board, B. Braun Melsungen AG Research Grant, C. R. Bard, Inc Consultant, C. R. Bard, Inc Consultant, Medtronic, Inc Consultant, Siemens AG Consultant, Eli Lilly and Company Scientific Advisory Board, Surefire Medical, Inc Scientific Advisory Board, Rene Medical

Maria Kertesz RN, Abstract Co-Author: Nothing to Disclose

Nancy A. Obuchowski PhD, Abstract Co-Author: Research Consultant, Siemens AG Research Consultant, Hologic, Inc Research Consultant, CVUS Research Consultant, Elucid Bioimaging Inc

Mark Jason Sands MD, Abstract Co-Author: Nothing to Disclose

To compare thrombosis rates between flouroquinolone surface modified polyurethane PICCs & polyurethane PICCs

From 11/6/2012 through 2/6/2013, 1203 consecutive patients had 890 PICCs (642 Polyurethane [PU] & 246 Surface Modified Polyurethane [SM]) and 485 Midline catheters (481 PU & 5 SM). Catheter type was determined by preference of the placing nurse. In 10 patients, the type of PICC used was not recorded so these were excluded. Using multivariable logistic regression, rate of venous thrombosis associated with the catheter was compared between the two groups and correlated with variables such as age, gender, side of catheter placement, size of catheter, # of lumens, vein used, catheter length, whether the vein reached its desired target (SVC in PICC & Axillary Vein in Midlines), and an ICD-9 cancer diagnosis. Central Line Associated Bacterial Systemic Infections (CLABSI) were also collected.

In univariate analysis of PICCs, left side of insertion and cancer diagnosis were predictors of thrombosis (5.5% v. 2.1% for left v. right p=0.008 and 50% v. 2.5% p<0.0001 for cancer). In multiple-variable analysis correcting for age, side of placement & cancer diagnosis, there were 24 thromboses in 642 PU PICCs while there were only 3 in 248 SM PICCs 3.7% v. 1.2% with an odds ratio of 6.2 (p=0.01). In 5 F catheters, the odds ratio was 5.0 (p=0.012). When 179 5F SM catheters were compared to 387 4F PU catheters the thrombosis rates were similar (p=0.272). There was no difference  between 4F & 5F SM catheters. Thrombosis rate in PU midline catheters was higher than in PU PICCs (5.4% v. 3.7%). Side of placement was not a predictor of thrombosis. Shorter catheter length (p=0.014) and cancer diagnosis (p=0.002) were predictors of thrombosis in midlines. While no SM midlines thrombosed, the sample size was too small (n=5) for a generalizable comparison of midline catheters. There were no CLABSI events in either group.

Surface modification of PICCs reduces thrombosis by a factor of 6.2 overall and by a factor of 5 in 5F PICCs. Left sided PICC placement and cancer diagnosis increase the risk of venous thrombosis. Midline PU catheters have a higher associated thrombosis rate than PU PICC lines and while side of placement is not an independent risk factor for thrombosis, shorter length & cancer diagnosis are.

Surface modified PICC lineshave lower thrombosis rates which will improve patient safety.

McLennan, G, Kertesz, M, Obuchowski, N, Sands, M, Flouroquinolone Based Surface Modifying Molecules Reduce Venous Thrombosis Rates Associated with PICC Lines.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008048.html