PULMONARY-EMBOLISM IN PATIENTS WITH UPPER EXTREMITY DVT ASSOCIATED TOVENOUS CENTRAL LINES - A PROSPECTIVE-STUDY

We performed a prospective study in 86 consecutive patients with centr al vein catheter-related deep venous thrombosis (DVT) of the upper ext remity, to evaluate the prevalence of pulmonary embolism (PE), and to identify clinical variables that would increase the likelihood of deve loping PE in an individual patient. Since upper-extremity DVT was esta blished, all patients received intravenous heparin therapy. Then, a ve ntilation-perfusion lung scan was obtained within 24 h of DVT diagnosi s, whether respiratory symptoms were present or not. Six points of cli nical information were recorded on entering in the study, and then com pared with the scintigraphic findings: age, sex, the underlying diseas e, the catheter material, the character of the infusate, and the durat ion of cannulation. Thirteen patients were considered to have PE. Sixt y-six patients were finally classified as having a normal lung scan, a nd 7 patients were excluded from the study (because of indeterminate l ung scan 6; because of femoropopliteal thrombosis simultaneously prese nt 1). Two out of the 13 patients with PE subsequently died because of recurrent, massive embolism, despite adequate heparin therapy. PE was more commonly present in patients with polyvinyle chloride or polyeth ylene catheters (10/38, 26%) as compared to patients with either polyu rethane or siliconized catheters (3/41, 7%; p <0.05, Chi-Square test; Odds Ratio = 4.52, 95% CI 1.01-23.07). We conclude that PE is not a ra re event in these patients, and it may be life-threatening even despit e adequate heparin therapy. Since the more recently available soft cat heters seem to carry a lower risk of developing PE, there seems to be no reason to continue to use polyvinyl chloride or polyethylene cathet ers.