Deep Venous Thrombosis Caused by Femoral Venous Catheters in Critically Ill Adult Patients

摘要

Study objectives: To determine the frequency of and potential risk factors for catheter-relatedndeep venous thrombosis (DVT) in critically ill adult patients.nDesign: Prospective, controlled, observational cohort study.nSetting: A mixed medical and surgical ICU in a university hospital.nPatients: All adult patients undergoing femoral vein catheterization.nInterventions: None.nMeasurements: ICU diagnosis, underlying disease, demographic data, type of catheter, compli-ncations during cannulation, use of anticoagulants, coagulation status, medications infused, andnduration of catheterization were recorded. Compression and duplex Doppler ultrasound studiesnof both femoral veins were performed prior to insertion, at 12 h after insertion, and daily untilncatheter removal. Follow-up investigation was performed at 24 h and 1 week after removal.nResults: Of 140 cases entered into the study, 124 were evaluated. Fourteen patients developedniliofemoral vein DVTs. Two were clinically obvious. Twelve (9.6%) were line related (uncannu-nlated leg normal) and two (1.6%) occurred only in the uncannulated leg (p 5 0.011; relative risk,n6.0; confidence interval, 1.5 to 23.5). Line-related DVT can occur any time from the day afterninsertion to 1 week after removal. The incidence of catheter-related DVT was unrelated tonnumber of insertion attempts, arterial puncture or hematoma, duration of catheterization,ncoagulation status, or type of infused medications. No other predisposing or protective factorsnwere identified. Three of the 12 patients with catheter-related DVT died. In no patient wasnclinical pulmonary embolus suspected.nConclusion: Although the femoral route is convenient and has potential advantages, the use ofnfemoral lines increases the risk of iliofemoral DVT. Catheter-related DVT may occur as soon asn1 day after cannulation and is usually asymptomatic. This increased risk should be carefullynconsidered when the femoral route of cannulation is chosen.