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

被引：14

作者：

Gentile, Ariane ^{[1
,2
]}

Petit, Laurent ^{[1
]}

Masson, Francoise ^{[1
]}

Cottenceau, Vincent ^{[1
]}

Bertrand-Barat, Josseline ^{[3
]}

Freyburger, Genevieve ^{[4
]}

Pinaquy, Catherine ^{[1
]}

Leger, Alain ^{[1
]}

Cochard, Jean-Francois ^{[1
]}

Sztark, Francois ^{[1
,5
]}

机构：

[1] Ctr Hosp Univ Bordeaux, Hop Pellegrin, Serv Anesthesie & Reanimat 1, F-33076 Bordeaux, France

[2] Hop Instruct Armees Robert Picque, F-33140 Villenave Dornon, France

[3] Ctr Hosp Univ Bordeaux, Hop Pellegrin, Dept Materiovigilance, F-33076 Bordeaux, France

[4] Ctr Hosp Univ Bordeaux, Hop Pellegrin, Hematol Lab, F-33076 Bordeaux, France

[5] Univ Bordeaux, INSERM, U1034, F-33600 Pessac, France

来源：

CRITICAL CARE | 2013年 / 17卷 / 03期

关键词：

central venous catheter; upper extremity deep vein thrombosis; risk factors; multiple trauma; intracranial hypertension; DEEP-VEIN THROMBOSIS; ORTHOPEDIC-SURGERY; CANCER-PATIENTS; BRAIN-INJURY; COMPLICATIONS; THROMBOPROPHYLAXIS; THROMBOEMBOLISM; ULTRASOUND; MANAGEMENT; DIAGNOSIS;

D O I：

10.1186/cc12748

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

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.

引用

页数：10

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