Anticoagulants; Heparin; APACHE; Acinetobacter Infections; Age Factors; Aged; Anticoagulants/therapeutic use; Catheterization, Central Venous/adverse effects; Catheterization, Central Venous/instrumentation; Confidence Intervals; Enterobacter; Enterobacteriaceae Infections; Female; Heparin/therapeutic use; Humans; Incidence; Klebsiella Infections; Male; Middle Aged; Prospective Studies; Pseudomonas Infections; Risk Factors; Sepsis/etiology; Serratia Infections; Staphylococcal Infections; Thrombosis/classification; Thrombosis/etiology; Time Factors; Ultrasonography, Doppler, Duplex; Critical Care; Jugular Veins/diagnostic imaging; Subclavian Vein/diagnostic imaging; Catheter-related sepsis; Central venous catheter; Duplex scanning; Internal jugular vein; Subclavian vein; Vein thrombosis; Pulmonary and Respiratory Medicine; Critical Care and Intensive Care Medicine; Cardiology and Cardiovascular Medicine
Abstract :
[en] OBJECTIVE: To evaluate the incidence and risk factors for catheter-related central vein thrombosis in ICU patients.
DESIGN: Observational prospective multicenter study.
SETTING: An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU.
PATIENTS: During an 18-month period, 265 internaljugular or subclavian catheters were included. Veins were explored by duplex scanning performed just before or < 24 h after catheter removal. Suspected risk factors of catheter-related central vein thrombosis were recorded.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Fifty-seven catheters were excluded from the analysis. Therefore 208 catheters were analyzed. Mean age of patients was 64+/-15 years, simplified acute physiologic score was 12+/-5, organ system failure score at insertion was 1+/-1, and mean duration of catheterization was 9+/-5 days. A catheter-related internal jugular or subclavian vein thrombosis occurred in 33% of the cases (42% [95% confidence interval (CI), 34 to 49%] and 10% [95% CI, 3 to 18%], respectively). Thrombosis was limited in 8%, large in 22%, and occlusive in 3% of the cases. Internal jugular route (relative risk [RR], 4.13; 95% CI, 1.72 to 9.95), therapeutic heparinization (RR 0.47; 95% CI, 0.23 to 0.99), and age >64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011).
CONCLUSIONS: Catheter-related central vein thrombosis is a frequent complication of central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Timsit, Jean-François; Division of Réanimation Polyvalente, Hôpital Saint Joseph, Paris, France
Farkas, Jean-Christophe; Unité de Réanimation, Clinique de la Défense, Nanterre, France
Boyer, Jean-Marc; Div. Reanimation Cardio-vasculaire, Hôpital Saint Joseph, Paris, France
Martin, Jean-Baptiste; Unité de Réanimation, Clinique de la Défense, Nanterre, France
Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs ; Division of Reanimation Polyvalente, Hôpital Saint Joseph, Paris, France
Renaud, Bertrand; Unité de Réanimation, Clinique de la Défense, Nanterre, France
Carlet, Jean; Division of Reanimation Polyvalente, Hôpital Saint Joseph, Paris, France
Language :
English
Title :
Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis.
Publication date :
July 1998
Journal title :
CHEST
ISSN :
0012-3692
eISSN :
1931-3543
Publisher :
American College of Chest Physicians, United States
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