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    Michigan Risk Score for PICC-Related Thrombosis

    Predicts risk of DVT in patients with peripherally inserted central catheter (PICC).
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    IMPORTANT

    This calculator is not yet externally validated and should therefore be used with caution.

    INSTRUCTIONS

    Use in patients ≥18 years old admitted to a medical service (i.e., not surgical). Do not use in pregnant patients.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Adult patients ≥18 years of age admitted to a medical service (i.e., not surgical).
    • Do not use in pregnant patients.
    • The Michigan Risk Score for PICC-Related Thrombosis helps estimate the risk of developing upper-extremity thrombosis in patients that receive peripherally inserted central catheters (PICCs).
    • Strongest predictors for risk were:
      • Triple-lumen PICCs.
      • PICCs placed in patients with a history of VTE in the past 30 days.
      • PICCs placed in the setting of active cancer.
    • Derived and internally validated in a cohort of 22,000 patients that received PICCs on medical wards or critical care settings. Extrapolation to dissimilar populations might not yield similar results.
    • A Michigan Risk Score Class I score is not necessarily “low risk” (incidence of DVT ~1%).
    • Not validated in surgical patients or patients undergoing surgery with a PICC.
    • Not validated in pediatric patients (<18 years of age).
    • Use prior to inserting a PICC to estimate the risk of upper-extremity/catheter-related thrombosis.
    • Can help support testing for thrombosis (e.g. ultrasound) in patients with vague symptoms but high risk for DVT.
    • Can support decision for longer duration of anticoagulation in patients with confirmed DVT related to PICC (higher risk – longer duration).

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Carefully consider the risks and benefits of using a PICC, especially if the risk of thrombosis is high.
    • Consider alternative devices (e.g. central venous catheters, ports, tunneled catheters) that can be placed in larger veins, if appropriate.

    Formula

    Addition of the selected points:

    Variable

    Points

    Another central venous catheter present*

    No

    0

    Yes

    +1

    WBC >12.0 × 10⁹/µL*

    No

    0

    Yes

    +1

    Number of PICCC lumens

    1

    0

    2

    +1

    3–4

    +2

    History of VTE

    Never

    0

    Yes, >30 days prior

    +2

    Yes, within 30 days

    +3

    Active cancer (on chemotherapy or admitted for cancer-related reasons)

    No

    0

    Yes

    +3

    *At the time of index PICC placement.

    Facts & Figures

    Interpretation:

    Michigan Risk Score

    Risk Class

    Probability of VTE

    0

    I

    0.9%

    1–2

    II

    1.6%

    3–4

    III

    2.7%

    ≥5

    IV

    4.7%

    Dr. Vineet Chopra

    About the Creator

    Vineet Chopra, MBBS, MSc, is an assistant professor of internal medicine and chief of the division of hospital medicine. He has published over 100 peer-reviewed papers and is associate editor of the American Journal of Medicine and the Journal of Hospital Medicine. Dr. Chopra's primary research interest is in identifying and preventing complications associated with central venous catheters, particularly peripherally inserted central catheters (PICCs).

    To view Dr. Vineet Chopra's publications, visit PubMed