Skip to main content
SpringerLink
Log in

Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

In vascular access practices, the internal vessel size is considered important, and a catheter to vessel ratio (CVR) is recommended to assist clinicians in selecting the most appropriate-sized device for the vessel. In 2016, new practice recommendations stated that the CVR can increase from 33 to 45% of the vessels diameter. There has been evidence on larger diameter catheters and increased thrombosis risk in recent literature, while insufficient information established on what relationship to vessel size is appropriate for any intra-vascular device. Earlier references to clinical standards and guidelines did not clearly address vessel size in relation to the area consumed or external catheter diameter. The aim of this manuscript is to present catheter-related thrombosis evidence and develop a standardized process of ultrasound-guided vessel assessment, integrating CVR, Virchow’s triad phenomenon and vessel health and preservation strategies, empowering an evidence-based approach to device placement. Through review, calculation and assessment on the areas of the 33 and 45% rule, a preliminary clinical tool was developed to assist clinicians make cognizant decisions when placing intravascular devices relating to target vessel size, focusing on potential reduction in catheter-related thrombosis. Increasing the understanding and utilization of CVRs will lead to a safer, more consistent approach to device placement, with potential thrombosis reduction strategies. The future of evidence-based data relies on the clinician to capture accurate vessel measurements and device-related outcomes. This will lead to a more dependable data pool, driving the relationship of catheter-related thrombosis and vascular assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Image 1
Image 2
Image 3
Image 4

Similar content being viewed by others

References

  1. Heil J, Miesbach W, Vogl T, Bechstein WO, Reinisch A (2017) Deep vein thrombosis of the upper extremity: a systematic review. Deutsches Ärzteblatt Int 114(14):244

    Google Scholar 

  2. Elman EE, Kahn SR (2006) The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review. Thromb Res 117(6):609–614

    Article  CAS  PubMed  Google Scholar 

  3. King MM, Rasnake MS, Rodriguez RG, Riley NJ, Stamm JA (2006) Peripherally inserted central venous catheter-associated thrombosis: retrospective analysis of clinical risk factors in adult patients. South Med J 99(10):1073–1078

    Article  PubMed  Google Scholar 

  4. Evans RS, Sharp JH, Linford LH, Lloyd JF, Tripp JS, Jones JP, Woller SC, Stevens SM, Elliott CG, Weaver LK (2010) Risk of symptomatic DVT associated with peripherally inserted central catheters. CHEST J 138(4):803–810

    Article  Google Scholar 

  5. Cotogni P, Pittiruti M (2014) Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med 3(4):80

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chopra V, Ratz D, Kuhn L, Lopus T, Lee A, Krein S (2014) Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors. J Thromb Haemost 12(6):847–854

    Article  CAS  PubMed  Google Scholar 

  7. Greene MT, Flanders SA, Woller SC, Bernstein SJ, Chopra V (2015) The association between PICC use and venous thromboembolism in upper and lower extremities. Am J Med 128(9):986–993

    Article  PubMed  Google Scholar 

  8. Holder MR, Stutzman SE, Olson DM (2017) Impact of ultrasound on short peripheral intravenous catheter placement on vein thrombosis risk. J Infus Nurs 40(3):176–182

    Article  PubMed  Google Scholar 

  9. Alexandrou E, Spencer TR, Frost SA, Parr MJ, Davidson PM, Hillman KM (2010) A review of the nursing role in central venous cannulation: implications for practice policy and research. J Clin Nurs 19(11–12):1485–1494

    PubMed  Google Scholar 

  10. Ramirez C, Malloch K, Agee C (2010) Evaluation of respiratory care practitioner central venous catheter insertion program. J Assoc Vasc Access 15(4):207–211

    Article  Google Scholar 

  11. Johnson D, Snyder T, Strader D, Zamora A (2017) Positive influence of a dedicated vascular access team in an acute care hospital. J Assoc Vasc Access 22(1):35–37

    Article  Google Scholar 

  12. Trerotola SO, Stavropoulos SW, Mondschein JI, Patel AA, Fishman N, Fuchs B, Kolansky DM, Kasner S, Pryor J, Chittams J (2010) Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 256(1):312–320

    Article  PubMed  Google Scholar 

  13. Reverse Taper Information. http://www.bardaccess.com/assets/literature/0736305_PICC_Taper_insert_web.pdf. Accessed 13 Jun 2017

  14. Fallouh N, McGuirk HM, Flanders SA, Chopra V (2015) Peripherally inserted central catheter-associated deep vein thrombosis: a narrative review. Am J Med 128(7):722–738

    Article  PubMed  Google Scholar 

  15. Allen AW, Megargell JL, Brown DB, Lynch FC, Singh H, Singh Y, Waybill PN (2000) Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 31(10):1309–1314 11(

    Article  Google Scholar 

  16. Sharp R, Gordon A, Mikocka-Walus A, Childs J, Grech C, Cummings M, Esterman A (2013) Vein measurement by peripherally inserted central catheter nurses using ultrasound: a reliability study. J Assoc Vasc Access 18(4):234–238

    Article  Google Scholar 

  17. Sharp R, Cummings M, Fielder A, Mikocka-Walus A, Grech C, Esterman A (2015) The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud 52(3):677–685

    Article  PubMed  Google Scholar 

  18. Sharp R, Grech C, Fielder A, Mikocka-Walus A, Esterman A (2016) Vein diameter for peripherally inserted catheter insertion: a scoping review. J Assoc Vasc Access 21(3):166–175

    Article  Google Scholar 

  19. Chopra V, Anand S, Krein SL, Chenoweth C, Saint S (2012) Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med 125(8):733–741

    Article  PubMed  Google Scholar 

  20. Gorski LA, Eddins J, Hadaway L, Hagle ME, Orr M, Richardson D, Williams PA (2007) Infusion nursing standards of practice. J Infus Nurs 34:S1–S110

    Google Scholar 

  21. Gorski LA, Eddins J, Hadaway L, Hagle ME, Orr M, Richardson D (2011) Williams PA Infusion nursing standards of practice. J Infus Nurs 34(1S):S1–S110

    Google Scholar 

  22. Gorski LA, Hadaway L, Hagle ME, McGoldrick M, Orr M (2016) Doellman D Infusion nursing standards of practice. J Infus Nurs 39(1S):S1–S159

    Google Scholar 

  23. Nifong TP, McDevitt TJ (2011) The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters. CHEST J 140(1):48–53

    Article  Google Scholar 

  24. Rossi UG, Rigamonti P, Tichà V, Zoffoli E, Giordano A, Gallieni M, Cariati M (2014) Percutaneous ultrasound-guided central venous catheters: the lateral in-plane technique for internal jugular vein access. J Vasc Access 15(1):56–60

    Article  PubMed  Google Scholar 

  25. Moureau NL, Trick N, Nifong T, Perry C, Kelley C, Carrico R, Leavitt M, Gordon SM, Wallace J, Harvill M, Biggar C (2012) Vessel health and preservation (Part 1): a new evidence-based approach to vascular access selection and management. J Vasc Access 13(3):351–356

    Article  PubMed  Google Scholar 

  26. Donnellan E, Khorana AA (2017) Cancer and venous thromboembolic disease: a review. Oncologist 22(2):199–207

    Article  PubMed  Google Scholar 

  27. Evans RS, Sharp JH, Linford LH, Lloyd JF, Woller SC, Stevens SM, Elliott CG, Tripp JS, Jones SS, Weaver LK (2013) Reduction of peripherally inserted central catheter-associated DVT. CHEST J 143(3):627–633

    Article  Google Scholar 

  28. Tran H, Arellano M, Chamsuddin A, Flowers C, Heffner LT, Langston A, Jo Lechowicz M, Tindol A, Waller E, Winton EF, Khoury HJ (2010) Deep venous thromboses in patients with hematological malignancies after peripherally inserted central venous catheters. Leuk Lymphoma 51(8):1473–1477

    Article  PubMed  Google Scholar 

  29. Ratz D, Hofer T, Flanders SA, Saint S, Chopra V (2016) Limiting the number of lumens in peripherally inserted central catheters to improve outcomes and reduce cost: a simulation study. Infect Control Hosp Epidemiol 37(7):811–817

    Article  PubMed  Google Scholar 

  30. Chopra V, Anand S, Hickner A, Buist M, Rogers MA, Saint S, Flanders SA (2013) Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 382(9889):311–325

    Article  PubMed  Google Scholar 

  31. Brewer C (2012) Reducing upper extremity deep vein thrombosis when inserting PICCs. Br J Nurs. doi:10.12968bjon.2012.21.Sup14.S12

  32. Grove JR, Pevec WC (2000) Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 11(7):837–840

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study did not apply for or receive any type of funding.

Author information

Authors and Affiliations

  1. Global Vascular Access, Scottsdale, AZ, USA

    Timothy R. Spencer

  2. Banner Gateway/MD Anderson Cancer Center, Phoenix, AZ, USA

    Keegan J. Mahoney

Authors
  1. Timothy R. Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keegan J. Mahoney
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TRS and KJM were the primary authors responsible for literature search, review, generation and editing of all versions of the manuscript. Both authors designed and created the Catheter Vessel Ratio Tool discussed in this manuscript. Both authors read and approved the final manuscript before submission.

Corresponding author

Correspondence to Timothy R. Spencer.

Ethics declarations

Conflict of interest

Timothy Spencer has received consultancy fees and speaker honorarium from Teleflex Inc. and Ethicon. Timothy Spencer is Presidential Advisor to the Australian Vascular Access Society (AVAS). Keegan Mahoney has received consultancy fees and speaker honorarium from Teleflex Inc.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was not required for the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spencer, T.R., Mahoney, K.J. Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio. J Thromb Thrombolysis 44, 427–434 (2017). https://doi.org/10.1007/s11239-017-1569-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-017-1569-y

Keywords

Search

Navigation