Central Vein Catheter-Related Thrombosis in Intensive Care Patients

Abstract

Objective: To evaluate the incidence and risk factors for catheter-related central vein thrombosis in ICU patients. Design: Observational prospective multicenter study. Setting: An 8-bed surgical ICU, a lO-bed surgical cardiovascular ICU, and a lO-bed medicalsurgical ICU. Patients: During an 18-month period, 265 intemaljugular 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. Interventions: None. Measurements and main results: 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 intemal 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. lntemal 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 catheterrelated sepsis was 2.62-fold higher when thrombosis occurred (p=O.OU). Conclusions: Catheter-related central vein thrombosis is a frequent complication of central venous catheterization in ICU patients and is closely associated with catheter-related sepsis. (CHEST 1998; 114:207-213)