Upper-extremity deep vein thrombosis after central venous catheterization via the axillary vein

Objective: To determine the frequency of central venous catheter-induced th rombosis of the axillary vein. Design: Prospective, controlled study, Setting: Tertiary care university center. Patients: Sixty patients in a medical-surgical intensive care unit who requ ired central venous catheterization via the axillary vein, Interventions: Single-lumen, silicone elastomer or polyurethane catheters w ere inserted for a mean duration of 14.7 +/- 7.4 days (range, 4-33 days), O n catheter removal, bilateral upper-extremity phlebographic examination was performed in each patient, The incidence of deep vein thrombosis in cathet erized arms was compared with that in uncatheterized arms. Measurements and Main Results: Of the 60 patients who underwent axillary ve in cannulation, one patient had clinical signs of arm vein thrombosis, but no patient had clinical sign of pulmonary embolism. There were 35 patients (58.3%) who developed positive phlebographic examinations homolateral to th e catheter. Fibrin sleeves that developed around the catheters were observe d in 28 patients (47%), Five patients (8.3%) had phlebographic signs of par tial axillary vein thrombosis: nonobstructive clots adherent to the vessel wall and/or the catheter, Two patients (3.3%) had phlebographic signs of co mplete axillary vein thrombosis, No thrombosis was observed in patients wit h catheterizations lasting less than or equal to 6 days, two cases were obs erved for duration of 7-14 days, and five cases were observed for duration of greater than or equal to 15 days (p < .01). In the seven patients with a xillary vein thrombosis, the vessel was cannulated with fewer than three pu ncture attempts, and the mean duration for catheter insertion (10 +/- 2.5 m in) was not different from that of patients with no axillary vein thrombosi s (14 +/- 9 min). Conclusions: Based an the data from the present study, we conclude that axi llary vein catheterization is associated with a 11.6% frequency of upper-ex tremity deep vein thrombosis. This rate of vein thrombosis is similar to th at observed after internal jugular or subclavian vein cannulation, Given th e acceptable rate of this clinically important complication, axillary vein cannulation offers an attractive alternative site for catheter insertion to the internal jugular or subclavian vein in the critically ill, Because thr ombosis is rare or absent in catheterizations lasting <15 days, it seems wi se to withdraw axillary catheters after a maximum of 2 wks.