Prunet Bertrand, Lacroix Guillaume, Bordes Julien, Poyet Raphael, D'Aranda Erwan, Goutorbe Philippe
Intensive Care Unit, Sainte Anne Hospital, Boulevard Sainte Anne, 83000 Toulon, France.
Cases J. 2009 Sep 8;2:8857. doi: 10.1186/1757-1626-0002-0000008857.
Intravascular cooling and warming catheters are among a range of proliferating technologies used for temperature control. Complications related to the use of these devices are few, and no definitive evidence has been presented thus far to indicate any differences in complication rates between these balloon catheters and other central vein catheters. We report two cases of cooling and warming catheter-related venous thrombosis. They are the both first ones report of this kind in the literature.
The first case was a 17-year-old man admitted with severe head trauma. On day 6, he presented with severe intracranial hypertension, requiring increased medical treatment: mannitol osmotherapy, barbiturate-induced coma, and mild therapeutic hypothermia. A double-lumen Alsius CoolLine catheter was placed in the inferior veina cava via the left femoral vein and active cooling was begun. On day 10, physical examination of the left inguinal area and echo-doppler revealed catheter-related thrombophlebitis with left iliocaval vein occlusion. The second case was a 42-year-old man admitted with a severe burn. On day 2, the patient was taken to the operating room for the first staged excision of his burn wounds. A triple lumen Alsius Icy catheter was placed in the inferior vena cava via the right femoral vein and active core warming of the patient was begun. From day 2 to day 7, active core warming of the patient was maintained. On day 7, he presented with a septic thrombophlebitis. Echo-doppler revealed a 4-cm-long thrombus at the femoral catheter site with complete blood flow obstruction and blood cultures and catheter tip were positive for methicillin-resistant Staphylococcus aureus.
Although generally considered safe, cooling and warming catheters can be associated with mechanical complications such as catheter-related venous thrombosis. Intensivists who use these devices should be aware of this possible complication. Finally, as with any other invasive catheter, to reduce the risk of complications, the catheter should be removed promptly when no longer needed.
血管内冷却和加热导管是用于温度控制的一系列不断增多的技术之一。与使用这些设备相关的并发症很少，迄今为止，尚无确凿证据表明这些球囊导管与其他中心静脉导管在并发症发生率上存在任何差异。我们报告了两例与冷却和加热导管相关的静脉血栓形成病例。它们均为文献中此类病例的首例报道。
首例病例为一名17岁男性，因严重头部外伤入院。在第6天，他出现严重颅内高压，需要加强治疗：甘露醇渗透疗法、巴比妥酸盐诱导昏迷和轻度治疗性低温。通过左股静脉将双腔Alsius CoolLine导管置入下腔静脉，并开始主动冷却。在第10天，对左腹股沟区进行体格检查及超声多普勒检查发现导管相关血栓性静脉炎伴左髂总静脉闭塞。第二例病例为一名42岁男性，因严重烧伤入院。在第2天，患者被送往手术室进行首次烧伤创面分期切除。通过右股静脉将三腔Alsius Icy导管置入下腔静脉，并开始对患者进行主动核心体温加热。从第2天到第7天，持续对患者进行主动核心体温加热。在第7天，他出现了感染性血栓性静脉炎。超声多普勒检查显示股静脉导管部位有一个4厘米长的血栓，血流完全阻塞，血培养和导管尖端培养对耐甲氧西林金黄色葡萄球菌呈阳性。
尽管冷却和加热导管通常被认为是安全的，但它们可能与机械并发症相关，如导管相关静脉血栓形成。使用这些设备的重症监护医生应意识到这种可能的并发症。最后，与任何其他侵入性导管一样，为降低并发症风险，当不再需要时应及时拔除导管。
