Subclavian central venous catheter related thrombosis, risk factors and influence of polyurethane type

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Intravenous literature: Gentile, A., Petit, L., Masson, F., Cottenceau, V., Bertrand-Barat, J., Freyburger, G., Pinaquy, C., Leger, A., Cochard, J.F. and Sztark, F. (2013) Subclavian central venous catheter related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type. Critical Care Forum. 17(3), p.R103. [Epub ahead of print].

Abstract:

INTRODUCTION: The incidence of deep venous thrombosis (DVT) related to central venous catheter (CVC) varies considerably in intensive care units depending on the population included. The aim of this study was to determine subclavian central venous catheter (SCVC)-related DVT risk factors in severely traumatized patients with regard to two kinds of polyurethane catheters.

METHODS: Critically ill trauma patients needing SCVC for their usual care were prospectively included in an observational study. Depending on the month of inclusion, patients received one of the two available products in the emergency unit: either an aromatic polyurethane (Ar) SCVC or an aliphatic polyurethane (Al) SCVC. Patients were screened weekly by ultrasound for SCVC-related DVT. Potential risk factors were collected, including history-related, trauma-related and SCVC-related characteristics.

RESULTS: 186 patients were included with a median injury severity score (ISS) of 30 and a high rate of severe brain injuries (21% of high intracranial pressure). Incidence of SCVC-related DVT was 37 % (IC95% 26-40) in patients or 20/1000 catheter-days. SCVC-related DVT occurred within 8 days in 65% of cases. There was no significant difference in DVT rates between Ar and Al SCVC groups (38% vs 36%). SCVC-related DVT independent risk factors were an age of greater than 30 years, intracranial hypertension (ICHT), massive transfusion (>10 RBP), SCVC tip position in the internal jugular or in the innominate vein, and ipsilateral jugular catheter.

CONCLUSIONS: SCVC-related DVT concerned a third of these severely traumatized patients and were mostly clinically silent. Incidence did not depend on the type of polyurethane but was related to an age of greater than 30 years, ICHT or misplacement of the SCVC. Further studies are needed to assess the cost-effectiveness of routine screening in these patients in whom thromboprophylaxis may be hazardous.

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