P056 - Impact of Catheter-to-Vessel Ratio Calculation Technology on Catheter-Related Thrombosis in Peripherally Inserted Central Catheters: A Retrospective Review of Records

Kristin Hartner, DNP, RN - Main Line Health
Elizabeth Kelly, MSN, RN - Main Line Health
Joyce Plank, BSN, RN, VA-BC™ - Main Line Health

Purpose: : Research suggests that using a catheter-to-vessel-ratio (CVR) of 45% or less can minimize this risk of catheter-related thrombosis (CRT). This retrospective study was implemented to evaluate the impact of utilizing an ultrasound device that can measure catheter-to vessel ratio with peripherally inserted central catheter insertion by the vascular access team.

Methods: : This project used a pre- and post-intervention design to look at the incidence of PICC related CRT before and after implementation of a device that can accurately measure catheter to vessel ratio. Pre-intervention data was collected retrospectively through chart review and included: PICC size, CVR, location of PICC, previous history of DVT or pulmonary embolism (PE), previous or current cancer diagnosis, anticoagulation medication, if any, and DVT/CRT resulting from the current PICC insertion. The same information with the addition of COVID diagnosis was collected post intervention for comparison.

Results: : In the post-intervention period, 27.8% of patients had COVID. The average (SD) CVR was 31.0 (10.4). 14.3% of patients had a CVR < 20, 48.4% had a CVR between 20-35, 35.1% had a CVR between 36-45, and 2.2% (n=11) patients had a CVR > 45.
After excluding the COVID patients, there were six cases of DVT, seven cases of thrombosis, and 13 cases of DVT or thrombosis in the full patient cohort (combining pre- intervention and post-intervention).
Systemwide, after excluding the COVID patients, the pre- vs post-intervention rates were:
DVT: 1.3% vs 0.3%
Thrombosis: 1.0% vs 0.8%
DVT or Thrombosis: 2.3% vs 1.1%
While there was no statistically significant difference, data suggests that using a CVR of 45% or less decreases the incidence of CRT. Results also reinforce previous research that cancer diagnosis as well as insertion of larger gauge PICCs were associated with deep vein thrombosis.

Limitations:: A major limitation of the project was the presence of the COVID pandemic impacting the project timeline and sample characteristics. In addition, the project concluded one month after the post-intervention PICC data was collected. Since PICCs can be used for months after insertion, there is a chance DVTs/thromboses were missing.

Conclusions: : The findings of this project suggested that utilization of an ultrasound device that can accurately measure CVR decreased the incidence of DVT and thrombosis in patients with PICCs placed by the vascular access team using CVR of 45% or less. Additionally, the outcomes of this project support previous findings that recommend that all staff who insert PICCs should utilize all strategies in the prevention of PICC associated DVTs, such as the use of ultrasound guidance for placement, vessel selection, CVR calculation, and the importance of identifying those at high risk.