Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients

Study objectives: To determine the frequency of and potential risk factors for catheter-related deep venous thrombosis (DVT) in critically ill adult p atients. Design: Prospective, controlled, observational cohort study. Setting: A mixed medical and surgical ICU in a university hospital, Patients: All adult patients undergoing femoral vein catheterization. Interventions: None, Measurements: ICU diagnosis, underlying disease, demographic data, type of catheter, complications during cannulation, use of anticoagulants, coagulat ion status, medications infused, and duration of catheterization were recor ded. Compression and duplex Doppler ultrasound studies of both femoral vein s were performed prior to insertion, at 12 h after insertion, and daily unt il catheter removal, Follow-up investigation was performed at 2-1 h and 1 w eek after removal. Results: Of 140 cases entered into the study; 124 were evaluated. Fourteen patients developed iliofemoral vein DVTs. Two were clinically obvious. Twel ve (9.6%) were line related (uncannulated leg normal) and two (1.6%) occurr ed only in the uncannulated leg (p = 0.0111 relative risk, 6.0; confidence interval, 1.5 to 23.5). Line-related DVT can occur any time from the day af ter insertion to 1 week after removal. The incidence of catheter-related DV T: was unrelated to number of insertion attempts, arterial puncture or hema toma, duration of catheterization, coagulation status, or type of infused m edications, No other predisposing or protective factors were identified. Th ree of the le patients with catheter-related DVT died, Is no patient was cl inical pulmonary embolus suspected. Conclusion: Although the femoral route is convenient and has potential adva ntages, the use of femoral lines increases the risk of iliofemoral DVT. Cat heter-related DFT may occur as soon as 1 day after cannulation and is usual ly asymptomatic. This increased risk should be carefully considered when th e femoral route of cannulation is chosen.