BMI a Factor in Risk of Thromboembolic Events With Peripherally Inserted Central Catheters

A nurse flushes out a patient's PICC line.
A nurse flushes out a patient’s PICC line.
A study sought to determine whether overweight/obesity is a factor in the development of thrombosis in cancer patients with peripherally inserted central catheters.

Peripherally inserted central catheters (PICCs) have a lot of advantages. Easy to implant, they provide an access point for intravenous therapy and parenteral nutrition and reduce the need for repeated venipuncture. But they come with risks of complications, such as thromboembolic events, especially in patients with cancer. 

A team of researchers conducted a review of the scientific literature with the goal of learning more about whether body mass index (BMI) could be a risk factor for thromboembolic events in oncology patients with PICCs. The results of their review were published in the Journal of Vascular Nursing.

A total of 6 studies met the inclusion criteria for this review, providing data from 2431 patients with PICCs. Their endpoint was relative risk of PICC-related thromboembolic events in patients who are normal weight/underweight (BMI <25 kg/m2) compared with patients who are overweight/obese (BMI ≥25 kg/m2).

Overall, 15.1% of the patients developed PICC-related thrombosis. However, risk of PICC-related complications in patients with overweight/obesity was twice that of those with BMI less than 25 kg/m2, noted the researchers.

Specifically, incidence of thromboembolic events was 28% in the overweight/obese cohort, whereas incidence was 13% in the normal weight/underweight cohort (pooled relative risk, 2.06%; 95% CI, 1.21-3.49; P <.001).

Additional research is recommended, as evaluating anthropometric and nutritional data could provide information about malnutrition that should be integrated with other data to create an objective assessment. The assessment could then be used to determine patients’ potential risk for thromboembolic events, as well as inform a nursing protocol for assessing patients who may require additional monitoring.  

This study was limited by its retrospective and observational nature. The percentage of patients who actually experienced PICC-related thrombosis may have been higher than reported. Only symptomatic thrombosis was noted in the reviewed studies, and Doppler ultrasound was not routinely performed. The study data were limited to patients’ BMI determined at the beginning of each study, rather than possible re-evaluations along the way.

The studies included in this review also did not specify if patients’ BMI fell to less than the limit designated for underweight (BMI <18.5 kg/m2). “This is an important issue to clarify,” the researchers explained, because being underweight also contributes to patients developing PICC-related thrombosis.


Simonetti G, Bersani A, Tramacere I, et al. The role of body mass index in the development of thromboembolic events among cancer patients with PICCs: a systematic review. J Vasc Nurs. 2022;40(1):11-16. doi:10.1016/j.jvn.2021.10.001

This article originally appeared on Oncology Nurse Advisor