Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis

• Published in: Chest Vol. 114; no. 1; p. 207
• Main Authors: Timsit, J F, Farkas, J C, Boyer, J M, Martin, J B, Misset, B, Renaud, B, Carlet, J
• Format: Journal Article
• Language: English
• Published: United States 01-07-1998
• Subjects: Acinetobacter Infections; Age Factors; Aged; Anticoagulants - therapeutic use; APACHE; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Confidence Intervals; Critical Care; Enterobacter; Enterobacteriaceae Infections; Female; Heparin - therapeutic use; Humans; Incidence; Jugular Veins - diagnostic imaging; Klebsiella Infections; Male; Middle Aged; Prospective Studies; Pseudomonas Infections; Risk Factors; Sepsis - etiology; Serratia Infections; Staphylococcal Infections; Subclavian Vein - diagnostic imaging; Thrombosis - classification; Thrombosis - etiology; Time Factors; Ultrasonography, Doppler, Duplex
• ISSN: 0012-3692
• DOI: 10.1378/chest.114.1.207

To evaluate the incidence and risk factors for catheter-related central vein thrombosis in ICU patients.
Observational prospective multicenter study.
An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU.
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.
None.
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).
Catheter-related central vein thrombosis is a frequent complication of central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.