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

Abstract

INTRODUCTION:

The incidence of deep venous thrombosis (DVT) related to a central venous catheter varies considerably in ICUs 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 a 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 SCVC or an aliphatic polyurethane 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:

A total of 186 patients were included with a median Injury Severity Sore of 30 and a high rate of severe brain injuries (21% of high intracranial pressure). Incidence of SCVC-related DVT was 37% (95% confidence interval: 26 to 40) in patients or 20/1,000 catheter-days. SCVC-related DVT occurred within 8 days in 65% of cases. There was no significant difference in DVT rates between the aromatic polyurethane and aliphatic polyurethane SCVC groups (38% vs. 36%). SCVC-related DVT independent risk factors were age>30 years, intracranial hypertension, massive transfusion (>10 packed red blood cell units), SCVC tip position in the internal jugular or in the innominate vein, and ipsilateral jugular catheter.

CONCLUSION:

SCVC-related DVT concerned one-third of these severely traumatized patients and was mostly clinically silent. Incidence did not depend on the type of polyurethane but was related to age>30 years, intracranial hypertension 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.

• Authors: Ariane Gentile, Laurent Petit, Françoise Masson, Vincent Cottenceau, Josseline Bertrand-Barat, Geneviève Freyburger, Catherine Pinaquy, Alain Léger, Jean-François Cochard, François Sztark
• Journal: Critical care (London, England) (Crit Care) Vol. 17 Issue 3 Pg. R103 (May 29 2013) ISSN: 1466-609X [Electronic] England
• PMID: 23718723 (Publication Type: Journal Article, Observational Study)

Chemical References

• Polyurethanes

Topics

• Adult
• Central Venous Catheters (adverse effects)
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Polyurethanes (adverse effects, chemistry)
• Prospective Studies
• Risk Factors
• Subclavian Vein
• Venous Thrombosis (diagnosis, epidemiology, therapy)
• Wounds and Injuries (diagnosis, epidemiology, therapy)
• Young Adult