In a recent article cited on IVTEAM concerned with PICC associated upper extremity deep venous thrombosis the authors present an insight into how a patient initially presents with a suspected upper extremity DVT. They discuss Upper extremity DVT and present some excellent ultrasound images of the case in question. However, they fail to describe or acknowledge PICC gauge size or tip location. The text hints that the tip location may have been suboptimal, stating “Long-axis ultrasonographic evaluation of the axillary and subclavian veins near the PICC line tip revealed deep venous thrombosis of both the axillary and subclavian veins” (Rosen, Chang, Kaufman, Soderman, and Riley 2012).
It is vital that when writing about PICC associated upper extremity deep venous thrombosis authors include a section on issues such as PICC gauge size, type of PICC and elements on PICC design. Furthermore, authors should describe the peripheral vessel used for access and the tip location of the PICC when the patient presents with a suspected upper extremity DVT.
Finally, upper extremity DVT should not be simply be attributed to the presence of a PICC. We must look beyond the PICC. If gauge size or tip location are suboptimal then these are the likely factors that may have contributed to upper DVT formation.
Rosen, T., Chang, B., Kaufman, M., Soderman, M. and Riley, D.C. (2012) Emergency department diagnosis of upper extremity deep venous thrombosis using bedside ultrasonography. Critical Ultrasound Journal. 4(1), p.4.