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




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Critical Care

, 17:R103

First Online: 29 May 2013Received: 14 December 2012Revised: 20 February 2013Accepted: 29 May 2013

Abstract

IntroductionThe 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.

MethodsCritically 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.

ResultsA 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.

ConclusionSCVC-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.

Keywordscentral venous catheter upper extremity deep vein thrombosis risk factors multiple trauma intracranial hypertension AbbreviationsAISAbbreviated Injury Score

Alaliphatic polyurethane

Araromatic polyurethane

CVCcentral venous catheter

DVTdeep venous thrombosis

ICHTintracranial hypertension

IQRinterquartile range

ISSInjury Severity Score

LMWHlow molecular weight heparin

PEpulmonary embolism

SCVCsubclavian central venous catheter.

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Autor: Ariane Gentile - Laurent Petit - Françoise Masson - Vincent Cottenceau - Josseline Bertrand-Barat - Geneviève Freyburger -

Fuente: https://link.springer.com/







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