Chest
Volume 117, Issue 1, January 2000, Pages 178-183
Journal home page for Chest

Clinical Investigations in Critical Care
Deep Venous Thrombosis Caused by Femoral Venous Catheters in Critically Ill Adult Patients

https://doi.org/10.1378/chest.117.1.178Get rights and content

Study objectives

To determine the frequency of andpotential risk factors for catheter-related deep venous thrombosis(DVT) in critically ill adult patients.

Design

Prospective, controlled, observational cohort study.

Setting

A mixed medical and surgical ICU in a universityhospital.

Patients

All adult patients undergoingfemoral vein catheterization.

Interventions

None.

Measurements

ICU diagnosis, underlying disease, demographic data, type of catheter, complications during cannulation, use of anticoagulants, coagulation status, medications infused, andduration of catheterization were recorded. Compression and duplex Doppler ultrasound studies of both femoral veins were performed priorto insertion, at 12 h after insertion, and daily until catheterremoval. Follow-up investigation was performed at 24 h and 1 weekafter removal.

Results

Of 140 cases entered into thestudy, 124 were evaluated. Fourteen patients developed iliofemoral veinDVTs. Two were clinically obvious. Twelve (9.6%) were line related(uncannulated leg normal) and two (1.6%) occurred only in theuncannulated leg (p = 0.011; relative risk, 6.0; confidence interval,1.5 to 23.5). Line-related DVT can occur any time from the day afterinsertion to 1 week after removal. The incidence of catheter-relatedDVT was unrelated to number of insertion attempts, arterial puncture orhematoma, duration of catheterization, coagulation status, or type ofinfused medications. No other predisposing or protective factors wereidentified. Three of the 12 patients with catheter-related DVT died. Inno patient was clinical pulmonary embolus suspected.

Conclusion

Although the femoral route is convenient andhas potential advantages, the use of femoral lines increases the riskof iliofemoral DVT. Catheter-related DVT may occur as soon as 1 dayafter cannulation and is usually asymptomatic. This increased riskshould be carefully considered when the femoral route of cannulation ischosen.

Section snippets

Materials and Methods

The study was performed in a 16-bed, mixed medical and surgical ICU at a university teaching hospital. Approval for the study was obtained from the Clinical Research Ethics Committee of the Chinese University of Hong Kong. Informed consent was obtained from a senior relative when the patient's condition precluded provision of his or her own consent. All adult patients undergoing femoral-route central venous catheterization between January 1996 and February 1998 were recruited for the study. The

Results

Over a 25-month period, 140 patients were entered into the study. Sixteen patients were withdrawn after entry into the study: 1 patient was found to be lupus anticoagulant–positive (this patient developed a line-related DVT); 6 patients survived < 24 h after insertion of the femoral catheter; 3 patients had attempted cannulation of the contralateral vein; and 6 patients required cannulation of the contralateral femoral vein before the follow-up period was complete. Thus, 124 patients were

Discussion

This prospective study demonstrates a consistent and clinically important increase in iliofemoral DVT following the use of femoral venous catheters. Patients with femoral lines in situ can expect to have, on average, a sixfold increased risk of iliofemoral DVT. Despite this being the largest study to date, the confidence intervals are wide and the risk may be as low as twofold or as high as 20-fold the baseline risk of iliofemoral DVT in noncatheterized limbs. Other studies performed to

References (32)

  • B Bansmer et al.

    Complications following use of indwelling catheters of inferior vena cava

    JAMA

    (1958)
  • NA Smyrnios et al.

    The jury on femoral vein catheterization is still out

    Crit Care Med

    (1997)
  • O Durbec et al.

    A prospective evaluation of the use of femoral venous catheters in critically ill adults

    Crit Care Med

    (1997)
  • O Durbec et al.

    Lower extremity deep vein thrombosis: a prospective randomized, controlled trial in comatose or sedated patients undergoing femoral vein catheterization

    Crit Care Med

    (1997)
  • KM Ho et al.

    A comparison of central venous pressure and common iliac venous pressure in critically ill mechanically ventilated patients

    Crit Care Med

    (1998)
  • SI Seldinger

    Catheter replacement of the needle in percutaneous arteriography

    Acta Radiol

    (1953)
  • Cited by (122)

    • Pharmacokinetic profiles of intravenous versus subcutaneous administration of low molecular weight heparin for thromboprophylaxis in critically ill patients: A randomized controlled trial

      2022, Journal of Critical Care
      Citation Excerpt :

      Critically ill patients carry a high risk of thromboembolic events due to various factors associated with severe illness including sepsis, surgery, bed rest, vasopressor use, venous catheters, respiratory or renal failure [1-3].

    View all citing articles on Scopus

    Currently at St. Mary's Hospital, London, UK

    View full text