Is an indwelling neuraxial or peripheral nerve catheter safe in a trauma patient who needs twice-daily low molecular weight heparin?

Abstract

A US serviceman suffered severe injuries to the lower extremities after stepping on a roadside bomb. He arrived at the hospital via critical care air transport having received a massive blood transfusion, a right traumatic above-the-knee amputation, and a left below-the-knee traumatic amputation, and other pelvic and abdominal injuries. Upon arrival, he was scheduled for irrigation and debridement (I&D) in the operating room (OR), followed by eventual extubation in the intensive care unit (ICU), but pain control was expected to limit his ability to wean from mechanical ventilation. The surgeon states that because he is a trauma patient with high risk of venous thromboembolism (VTE), he needs to be maintained on twice-daily (BID) low molecular weight heparin (LMWH), 30 mg subcutaneously (subq).