Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis.
OBJECTIVE
To evaluate the incidence and risk factors for catheter-related central vein thrombosis in ICU patients.


METHODS
Observational prospective multicenter study.


METHODS
An 8-bed surgical ICU, a 10-bed surgical cardiovascular ICU, and a 10-bed medical-surgical ICU.


METHODS
During an 18-month period, 265 internaljugular 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.


METHODS
None.


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 internal 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. Internal 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 catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011).


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.
Timsit
J F
JF
Division of Réanimation Polyvalente, Hôpital Saint Joseph, Paris, France.
Farkas
J C
JC
Boyer
J M
JM
Martin
J B
JB
Misset
B
B
Renaud
B
B
Carlet
J
J
D018806:APACHE; D000151:Acinetobacter Infections; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D016001:Confidence Intervals; D003422:Critical Care; D004754:Enterobacter; D004756:Enterobacteriaceae Infections; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007601:Jugular Veins / Q000000981:diagnostic imaging; D007710:Klebsiella Infections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology*; D016868:Serratia Infections; D013203:Staphylococcal Infections; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D013927:Thrombosis / Q000145:classification / Q000209:etiology*; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex
D000925:Anticoagulants; D006493:Heparin