Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio
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.
KeywordsVenous thrombosis Catheter to vein ratio Vessel measurement Ultrasound Patient Assessment Outcomes Standardization
This study did not apply for or receive any type of funding.
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.
Compliance with ethical standards
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.
This article does not contain any studies with human participants performed by any of the authors.
Informed consent was not required for the study.
- 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):244Google Scholar
- 13.Reverse Taper Information. http://www.bardaccess.com/assets/literature/0736305_PICC_Taper_insert_web.pdf. Accessed 13 Jun 2017
- 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):677–685CrossRefPubMedGoogle 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–S110Google 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–S110Google 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–S159Google 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):1473–1477CrossRefPubMedGoogle Scholar
- 31.Brewer C (2012) Reducing upper extremity deep vein thrombosis when inserting PICCs. Br J Nurs. doi:10.12968bjon.2012.21.Sup14.S12Google Scholar