A critical review of thromboembolic complications associated with central venous catheters

Abstract

Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications. Source:We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE. Principle findings:The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial. Conclusion:Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.

Intraoperative circulatory management using the FloTracTM system in laparoscopic liver resection

“…However, relative to pulmonary artery catheterization, which has been used to obtain the same parameters, the FloTrac system is a less‐invasive monitor for circulatory management because no large vessels need to be cannulated . In addition, a central venous catheter must be place preoperatively for CVP measurement, and the reported rate of complications associated with this procedure is 5%–19% ; however, the complication rate associated with peripheral arterial catheter placement is less than 1% . Monitoring using the FloTrac system, therefore, is considered to be a less invasive method than that based on measurements via the central venous catheter.…”

Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type

“…The rate of subclavian central venous catheter (SCVC)-related DVT found by routine Doppler ultrasound in the literature ranges from 4 to 67% with a mean incidence of 30%, of whom only 2% were symptomatic [3]. Several thrombotic risk factors have been identified and are related either to the patient's condition or to the catheter [4]. …”

The incidence of complications in comatose patients

“…According to Burns and McLaren (2008), central venous catheters are an indispensable component of critical care, allowing invasive monitoring, facilitating atrial stimulation and renal substitution therapy, and allowing the administration of parenteral nutrition and drugs. However, they are also associated with serious complications, including infection and thrombosis.…”