Main vein thrombosis in the practice of an intensive care doctor

Abstract

Purpose. To draw the attention of specialists to the question of incidence of catheter-associated and catheter-induced thrombosis in patients in intensive care units. To assess methods of visualization and monitoring of the great veins state using ultra-sound. To evaluate various links in the pathogenesis of thrombus formation and the possi-bilities of prevention and treatment. Materials and methods. More than 3500 ultrasound examinations have been per-formed in over 850 patients, both in the ICU and after the transfer of patients to specialized departments. The study included children aged from 1,5 months to 18 and adults, with one or more central venous catheters (CVCs). In the absence of contraindications, patients re-ceived prophylactic anticoagulant therapy (heparin at a dose of 50-100 U/kg/day). Ultra-sound was performed with a frequency of 4 to 85 times in one patient, depending on the de-tection and severity of CAT. The studies were carried out in B-mode using color and/or en-ergy mapping on ultrasound scanners Philips HD 11 (Philips, USA), SonoSite MicroMaxx (USA), Logiq E8 (GE, USA), Mindrey M 7 (Mindrey, China), Samsung HM 70 (Samsung, South Korea) using linear multi-frequency sensors 10-16 MHz. The patients underwent a complex ultrasound examination of the superior or inferior vena cava (depending on the assumed main vein thrombosis (TMV) localization), as well as the main veins of the extremities. Conclusions. The multifactorial nature of TMV development in ICU patients requires increased alertness to this complication, which necessitates ultrasound monitoring of the great veins in patients in intensive care units with installed CVCs. It should be noted that, despite the ongoing prophylaxis of TMV (including the use of anticoagulants), there is still a high risk of their development.