title: Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Ariane
authors.initials: A
authors.lastname: Gentile
authors.forename: Laurent
authors.initials: L
authors.lastname: Petit
authors.forename: Françoise
authors.initials: F
authors.lastname: Masson
authors.forename: Vincent
authors.initials: V
authors.lastname: Cottenceau
authors.forename: Josseline
authors.initials: J
authors.lastname: Bertrand-Barat
authors.forename: Geneviève
authors.initials: G
authors.lastname: Freyburger
authors.forename: Catherine
authors.initials: C
authors.lastname: Pinaquy
authors.forename: Alain
authors.initials: A
authors.lastname: Léger
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cochard
authors.forename: François
authors.initials: F
authors.lastname: Sztark
mesh_terms: D000328:Adult; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011140:Polyurethanes / Q000009:adverse effects* / Q000737:chemistry; D011446:Prospective Studies; D012307:Risk Factors; D013350:Subclavian Vein; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D011140:Polyurethanes