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

Critical Care

François Sztark³  Jean-François Cochard⁴  Alain Léger⁴  Catherine Pinaquy⁴  Geneviève Freyburger²  Josseline Bertrand-Barat¹  Vincent Cottenceau⁴  Françoise Masson⁴  Laurent Petit⁴  Ariane Gentile⁵ 

[1] Département de Matériovigilance, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux Cedex, France;Laboratoire d'Hématologie Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux Cedex, France;Université de Bordeaux, INSERM, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France;Service d'Anesthésie et de Réanimation 1, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux Cedex, France;Fédération d'anesthésie-réanimation, urgences, chirurgie ambulatoire, Hôpital d'Instruction des Armées Robert Picqué, 351 route de Toulouse, 33140 Villenave-d'Ornon, France

关键词: intracranial hypertension;    multiple trauma;    risk factors;    upper extremity deep vein thrombosis;    central venous catheter;   

Others  :  818129
DOI  :  10.1186/cc12748

 received in 2012-12-14, accepted in 2013-05-29,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Gentile et al.; licensee BioMed Central Ltd.

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