title: Early-onset thrombosis of internal jugular vein associated with introducer catheter for heart catheterization in cardiac surgery.
abstract: OBJECTIVE
  In cardiac surgery, Swan-Ganz catheter (SGC) is often necessary and is inserted before the intervention through an introducer catheter. Catheter-related thrombosis (CRT) is a frequent complication of this procedure and often remains subclinical. The aims of this prospective cohort study were to determinate the incidence of CRT after positioning an SGC through an introducer and to identify factors relating to their occurrence.
  
  
  METHODS
  One-hundred and sixteen cardiac surgery patients underwent ultrasound examination of the thoracic-cervical vessels, before and after introducer catheter removal. Data about drugs infused through the introducer catheter were also collected.
  
  
  RESULTS
  The incidence of internal jugular vein CRT was 26.7%, corresponding to 70.5 cases per 1,000 catheter days. The incidence of "fibrin sleeve" was 28.4%. All introducer catheter tips lay in the brachiocephalic vein or in the upper third of the superior vena cava. The incidence of CRT was not associated with duration of the placement of the introducer catheter (average 3.9±2 days) or the SGC (average of 2.4±1.7 days). Infusion of total parenteral nutrition and dextran showed a significantly increased risk of thrombosis in both univariate and multivariate analyses. An overly proximal position of the introducer catheter tip was strongly associated with CRT incidence.
  
  
  CONCLUSIONS
  The presence of an introducer catheter for SGC, even for a short time, is associated with a high incidence of early-onset CRT. This incidence is significantly related to the catheter tip being positioned in the brachiocephalic vein and to its use as a central venous access.
authors.affiliation: 1 Cardiac Surgery Intensive Care Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Trieste - Italy.
authors.forename: Adam
authors.initials: A
authors.lastname: Fabiani
authors.forename: Mauro
authors.initials: M
authors.lastname: Pittiruti
authors.forename: Savino
authors.initials: S
authors.lastname: Russo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sanson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002407:Catheterization, Swan-Ganz; D062905:Central Venous Catheters; D016009:Chi-Square Distribution; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007601:Jugular Veins / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology*