LOWER-EXTREMITY DEEP-VEIN THROMBOSIS - A PROSPECTIVE, RANDOMIZED, CONTROLLED TRIAL ILL COMATOSE OR SEDATED PATIENTS UNDERGOING FEMORAL VEINCATHETERIZATION

Objectives: To determine the rate of lower extremity deep vein thrombo sis after the use of femoral catheters in intensive care unit (ICU) co matose or sedated adults. Results were then compared with results of p atients undergoing superior vena cava catheterization. Design: Prospec tive, randomized, controlled, unblinded study. Setting: A mixed medica l/surgical ICU in a university hospital. Patients: Sixty-one comatose or sedated patients admitted to the ICU who underwent central venous c atheterization. Interventions: Patients were monitored for signs of th rombotic complications. On catheter removal, a lower-extremity bilater al phlebographic examination was performed in each patient. Measuremen ts and Main Results: After randomization, 31 patients underwent femora l vein catheterization and 30 patients underwent superior vena cava ca theterization, either by axillary (21 patients) or internal jugular ve in (10 patients) cannulation. Single lumen polyurethane catheters were inserted for a mean duration of 7.1 +/- 4.6 (so) days in the femoral vein group and 9.9 +/- 5.5 days in the superior vena cava group (p = N S). No patient had clinical signs of leg venous thrombosis or pulmonar y embolism during the study period. In each patient, lower extremity b ilateral phlebography was performed at the time of catheter removal. L eg phlebographies were normal in 18 (60%) patients in the femoral vein group and 26 (84%) patients in the superior vena cava group. Fibrin s leeves which developed around the femoral catheters were seen in seven (23.3%) patients in the femoral vein group and in no patients in the superior vena cava cannulation group. Three patients had femoral vein thrombosis, two (6.6%) patients in the femoral vein group (two nonobst ructive thromboses, adherent to the common femoral vein wall) and one (3.0%) patient in the superior vena cava group (nonobstructive thrombo sis which developed in the superficial femoral vein) (p = NS). Lower d eep extremities thrombosis developed in five (16.7%) patients in the f emoral vein group and in five (16%) patients in the superior vena cava group (p = NS). Conclusions: Femoral vein catheterization with a poly urethane catheter is associated with a lower rate of extremity deep ve in thrombosis which is similar to the rate observed after superior ven a cannulation in comatose or sedated patients. Femoral vein thrombosis was observed at a rate of 6.6% after femoral vein cannulation and a r ate of 3% after superior vena cava cannulation. Given the acceptable r ate of this clinically important complication, femoral vein cannulatio n offers an attractive alternative to insertion via the vena cava in t he critically ill.