High incidence of intravenous thrombi after short-term central venous catheterization of the internal jugular vein

Study Objective: To assess incidence and characteristics of intravenous (IV ) thrombi associated with short-term central venous catheterization through the internal jugular vein. Design: Prospective clinical study. Setting: University hospital. Patients: 81 patients undergoing cardiac surgery. Interventions: A triple-lumen central venous catheter was inserted into the right internal jugular vein immediately before surgery and removed 3 to 4 days later. Heparin at an IV dose of 15,000 IU/24 hours was started 6 hours after surgery and continued until the first postoperative morning, followe d by subcutaneous low molecular weight heparin 5,000 IU/day in combination wit oral aspirin 100 mg/day. Measurements and Main Results: Anatomy of the internal jugular vein and IV blood flow were studied using two-dimensional and color Doppler ultrasonogr aphy before insertion of the catheter and after its removal. Thrombi were f ound in 45 patients (56%). Twenty-five of these thrombi (56%) had the shape of a sleeve,and 20 thrombi (44%) were compact. Length of the thrombi was 1 .4 +/- 0.8 cm (mean +/- SD). Half of the thrombi floated with venous blood flow and half were stable. Neither impaired venous blood flow nor clinical signs of embolism or sepsis was found. follow-up studies in eight patients revealed that the thrombi had not disappeared 5 days after removal of the c atheter but had become smaller. Conclusion: The incidence if IV thrombi associated with short-term catheter ization of the internal jugular vein was igh despite prophylactic anticoagu lation. This finding reaffirms the importance of removing central venous ca theters as soon as clinically possible. Additional studies using specific o utcome tests are needed to thoroughly assess the clinical importance of thi s finding. (C) 1999 by Elsevier Science Inc.