Hrdy Ondrej, Strazevska Eva, Suk Petr, Vach Robert, Karlik Radim, Jarkovsky Jiri, Sas Igor, Gal Roman
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017 Dec;161(4):369-373. doi: 10.5507/bp.2017.034. Epub 2017 Aug 24.
One of the complications associated with central venous catheter (CVC) placement is catheter related deep vein thrombosis (CR-DVT). However a literature search revealed little evidence of this recognised complication. The primary aim of this study was to establish the incidence rate and risk factors for the development of CR-DVT in our critically ill adult patients.
All critically ill adult patients admitted to the medical-surgical ICU with CVC inserted were included in this observational prospective study. After catheter removal we performed duplex ultrasound examination to assess the patency of the vein and establish if CR-DVT was present.
A total number of 308 catheters met the inclusion criteria of which 198 were included in the statistical analysis. The CVC was inserted into a subclavian vein (SCV) in 139 (70%) cases and in an internal jugular vein (IJV) in 59 (30%) cases. The 28-day mortality rate was 14.1%. We found CR-DVT during duplex ultrasound examination in 47 (26%) of all cases. 33 (70%) of the CR-DVT were diagnosed in the IJV and 14 (30%) in the SCV. The risk factors for the development of CR-DVT we identified included cannulation of the IJV and the use of treatment dose of LMWH. The effect of CR-DVT on 28-day mortality was not statistically significant.
The risk factors for CR-DVT we identified were IJV as a site for CVC cannulation and the use of therapeutic anticoagulation prior to cannulation. Our recommendation would be preferential cannulation of a subclavian vein as opposed to an internal jugular vein in order to reduce the risk of CR-DVT.
中心静脉导管（CVC）置入相关的并发症之一是导管相关深静脉血栓形成（CR-DVT）。然而，文献检索显示关于这一公认并发症的证据很少。本研究的主要目的是确定我们重症成年患者中CR-DVT的发生率及危险因素。
本观察性前瞻性研究纳入了所有入住内科-外科重症监护病房且已插入CVC的重症成年患者。在拔除导管后，我们进行了双功超声检查以评估静脉通畅情况并确定是否存在CR-DVT。
共有308根导管符合纳入标准，其中198根纳入统计分析。139例（70%）CVC插入锁骨下静脉（SCV），59例（30%）插入颈内静脉（IJV）。28天死亡率为14.1%。在所有病例中，我们通过双功超声检查发现47例（26%）存在CR-DVT。33例（70%）CR-DVT在IJV中被诊断出，14例（30%）在SCV中被诊断出。我们确定的CR-DVT发生的危险因素包括IJV置管以及使用治疗剂量的低分子肝素（LMWH）。CR-DVT对28天死亡率的影响无统计学意义。
我们确定的CR-DVT危险因素是将IJV作为CVC置管部位以及在置管前使用治疗性抗凝。我们的建议是优先选择锁骨下静脉而非颈内静脉进行置管，以降低CR-DVT的风险。
