FEMORAL DEEP-VEIN THROMBOSIS ASSOCIATED WITH CENTRAL VENOUS CATHETERIZATION - RESULTS FROM A PROSPECTIVE, RANDOMIZED TRIAL

Objective: To determine the frequency of central venous catheter-induc ed deep vein thrombosis of the femoral vein. Design: Prospective, rand omized, controlled trial. Setting Tertiary care center. Patients: Fort y-five patients in a medical-surgical intensive care unit who required central venous catheterization. Interventions: Patients were randomiz ed to receive central venous catheterization in either upper (subclavi an or internal jugular reins) or lower (femoral vein) catheterization sites. Lower extremity duplex ultrasound examinations were performed b efore central venous catheter placement, after removal of the catheter , and 7 days after catheter removal. Ultrasound examinations were repo rted as positive, nondiagnostic, or negative for deep vein thrombosis. Measurements and Main Results: Of the 21 patients randomized to upper access sites, none developed positive or nondiagnostic duplex ultraso und examinations. Six (25%) of 24 patients randomized to the femoral a ccess site developed lower extremity deep vein thrombosis (p = .02). I n addition, seven (29%) patients randomized to the lower access site s ustained nondiagnostic ultrasound examinations. A total of 13 (54%) of 24 patients from the lower access group developed abnormal ultrasound examinations (p < .001). Age, duration of catheterization, coagulatio n profile, deep vein thrombosis prophylaxis, and Acute Physiology and Chronic Health Evaluation II scores were similar between the upper and lower access groups. Conclusions: Based on the data from this study, we concluded that femoral vein catheterization is associated with a 25 % frequency of lower extremity deep vein thrombosis compared with simi lar patients receiving subclavian or internal jugular vein catheters. The femoral vein remains an important emergency venous access route. P hysicians inserting femoral vein catheters should be aware of the risk of lower extremity deep vein thrombosis and should consider performin g lower extremity duplex ultrasound examinations on removal of femoral vein catheters.