Central Vein Catheter-Related Thrombosis in Intensive Care Patients

Incidence, Risks Factors, and Relationship With Catheter-Related Sepsis

¹ From the Division of Réanimation Polyvalente, Hôpital Saint Joseph, Paris, France
² From the Division of Réanimation Cardio-vasculaire, Hôpital Saint Joseph, Paris, France
³ From the Unité de Réanimation, Clinique de la Défense, Nanterre, France

Objective: To evaluate the incidence and risk factors for catheter-related central vein thrombosis in ICU patients.

Design: Observational prospective multicenter study.

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

Patients: During an 18-month period, 265 internal jugular 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.

Interventions: None.

Measurements and main 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.

Key Words: catheter-related sepsis • central venous catheter • duplex scanning • internal jugular vein • subclavian vein • vein thrombosis

Submitted on September 18, 1997
Accepted on December 8, 1997

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