Central venous catheter-related thrombosis in intensive care patients - incidence and risk factors: A prospective observational study

Abstract

Background. One of the complications associated with central venous catheter (CVC) placement is catheter related deep vein thrombosis (CR-DVT). However a literature search revealed little evidence of this recognised complication. The primary aim of this study was to establish the incidence rate and risk factors for the development of CR-DVT in our critically ill adult patients. Methods. All critically ill adult patients admitted to the medical-surgical ICU with CVC inserted were included in this observational prospective study. After catheter removal we performed duplex ultrasound examination to assess the patency of the vein and establish if CR-DVT was present. Results. A total number of 308 catheters met the inclusion criteria of which 198 were included in the statistical analysis. The CVC was inserted into a subclavian vein (SCV) in 139 (70%) cases and in an internal jugular vein (IJV) in 59 (30%) cases. The 28-day mortality rate was 14.1%. We found CR-DVT during duplex ultrasound examination in 47 (26%) of all cases. 33 (70%) of the CR-DVT were diagnosed in the IJV and 14 (30%) in the SCV. The risk factors for the development of CR-DVT we identified included cannulation of the IJV and the use of treatment dose of LMWH. The effect of CR-DVT on 28-day mortality was not statistically significant. Conclusion. The risk factors for CR-DVT we identified were IJV as a site for CVC cannulation and the use of therapeutic anticoagulation prior to cannulation. Our recommendation would be preferential cannulation of a subclavian vein as opposed to an internal jugular vein in order to reduce the risk of CR-DVT.

Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome

“…The femoral vein seems to be a high‐risk location for catheter‐associated DVTs in the ICU . As in a recently published study, we observed that the internal jugular vein had most catheter‐related DVTs. This finding might be important since internal jugular vein thrombosis previously has been associated with high mortality and morbidity rates in ICU patients …”

“…Limited data from ICU patients suggest that DVTs often occur in other locations than the lower extremities, and/or related to central venous catheters (CVCs) . Many VTEs in ICU patients are not clinically suspected, since clinical features may be absent or difficult to distinguish from other conditions.…”

Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: a retrospective cohort study

“…We speculated that the results were affected by differences among the prophylactic anticoagulants used and their doses. The efficacy of antithrombotic prophylaxis for CRT is controversial 5 – 8 , 29 , and no clear benefit has been determined for critically ill patients who received anticoagulant prophylaxis for CRT. Hence, individualised risk and benefit evaluations are required.…”

“…The reported CRT rates vary widely depending on the study design, patient selection, catheter type and location, and other factors. Previous studies 2 – 4 reported CRT rates of 42–56% in the internal jugular veins of critically ill patients, but the efficacy of antithrombotic prophylaxis for CRT remains controversial 5 – 8 .…”

Glomus Jugulare Tumor Presenting as Deep Vein Thrombosis

“…[2,5,6] There is a thrombosis rate of 25-30% of the IJV among all catheter placements; one study showed that IJV catheters have a 4 times greater risk of causing thrombosis than a subclavian catheter. [1,9,10] Another cause of a filling defect in IJV could be a primary leiomyosarcoma of the IJV. Leiomyosarcoma tumors are smooth muscle malignant tumor with higher occurrence in the inferior vena cava but can have intra-abdominal, subcutaneous, and vascular origin.…”