Bedside placement of inferior vena cava filters in the intensive care unit

The objective of this study was to determine the feasibility, cost-effectiv eness, and complications of bedside placement of inferior vena cava (IVC) f ilters in the intensive care unit (ICU) in the trauma patient. A prospectiv e trial involving 25 trauma patients admitted to Memorial Regional Hospital (Hollywood, Florida), a Level I trauma center, from April 1997 to April 19 98, meeting the criteria for insertion of a prophylactic IVC filter accordi ng to Eastern Association for the Surgery of Trauma trauma practice guideli nes was conducted. IVC filters were placed in the ICU with the use of a dig ital C-arm (Siemens) and strict adherence to sterile technique. Renal vein anatomy and size of the IVC were documented for every case. Charges for equ ipment and supplies were analyzed and compared with those placed in the rad iology suite and the operating room. Of 810 patients admitted as trauma ale rts during the study period, 25 had an IVC filter placed at the bedside in the ICU. The indications for filter placement included a contraindication t o anticoagulation and one of the following: severe pelvic fracture and/or a ssociated long-bone fracture (32%); bilateral lower extremity fractures (28 %); spinal cord injury with para- or quadriplegia (16%); femoral vein throm bosis (16%); and severe brain injury (8%). There were no intraoperative nor postoperative complications; overall mortality was 20 per cent, unrelated to the IVC filter placement. Average time for insertion was 47 minutes for the series and 20 minutes for the last five cases. Savings of $1844 or $224 5 per filter are obtained when IVC filters are placed in the ICU when compa red with the operating room or radiology:Suite, respectively. Bedside place ment of IVC filters in the ICU is a safer cost-effective method that can be performed without compromising the patient and avoids the potential disast ers involved in transporting critically ill patients.