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Risk Factors Associated With Catheter-Related Upper Extremity Deep Vein Thrombosis in Patients With Peripherally Inserted Central Venous Catheters: A Prospective Observational Cohort Study Part 2

Maneval, Rhonda E. DEd, MSN, RN; Clemence, Bonnie J. MSN, RN, CRNI®

doi: 10.1097/NAN.0000000000000042

This is the second part of a 2-part series that reports on the results of a prospective observational cohort study designed to examine risk factors associated with symptomatic upper extremity deep vein thrombosis (UEDVT) in patients with peripherally inserted central catheters (PICCs). Part 1, published in the May/June 2014 issue of the Journal of Infusion Nursing, provided an extensive review and critique of the literature regarding risk factors associated with catheter-related UEDVT and identified 28 suspected risk factors. A study was undertaken to examine each of the risk factors among 203 acute care patients with PICCs, 13 of whom experienced a UEDVT, yielding an incidence of 6.4%. The most common reason for admission was infection (33.5%), and the primary reason for insertion of the PICC was venous access (58.6%). Hypertension (P = .022) and obesity (P = .008), defined as a body mass index ≥30, were associated with UEDVT. The clinical symptoms of edema (P < .001) and a 3-cm or more increase in arm circumference (P < .001) in the PICC arm after PICC placement were associated with UEDVT. All other variables were not statistically significant. The results suggest that patients who are obese and hypertensive may be at greater risk for the development of UEDVT and that the physical finding of edema and increased arm circumference in the PICC arm are possibly suggestive of UEDVT.

Department of Undergraduate Nursing Education, Temple University, Philadelphia, Pennsylvania (Dr Maneval), and IV Therapy Department, Pinnacle Health System, Harrisburg, Pennsylvania (Ms. Clemence).

Rhonda E. Maneval, DEd, MSN, RN, is a professor of nursing and associate chair for undergraduate nursing education at Temple University in Philadelphia. She is also a nursing research consultant for PinnacleHealth System.

Bonnie J. Clemence, MSN, RN, CRNI®, is a staff nurse in the IV Therapy Department at PinnacleHealth System in Harrisburg, Pennsylvania. She has extensive experience as an infusion therapy and pediatric nurse.

Corresponding Author: Rhonda E. Maneval, DEd, MSN, RN, 3305 North Broad Street, Philadelphia, PA 19140 (

Bonnie J. Clemence received a grant from PinnacleHealth Foundation.

The authors of this article have no other conflicts of interest to disclose.

© Copyright 2014 by Infusion Nurses Society