Incidence of deep vein thrombosis in critically ill ICU patients with a femoral central venous catheter

Introduction

Deep vein thrombosis (DVT) is a serious complication that may develop in critically ill ICU patients as a consequence of immobilization, femoral central venous catheter (CVC) placement and activation of the thrombotic cascade.

Materials and methods

We investigated the epidemiology of DVT in critically ill ICU patients expected to be hospitalized for at least 2 weeks. We used a triplex examination of lower extremities on admission, on days 7 and 14, and on clinical suspicion of DVT.

Results

We included 50 consecutive patients of mean age 48.2 ± 3.8 years (15 females) having illness severity on admission of SAPS II score 51.8 ± 2.9 and APACHE II score 23.3 ± 1.4. Six of the patients did not experience a femoral CVC during hospitalization. The mean ICU stay was 18.8 ± 0.8 days (range 13–28 days). All patients were receiving low molecular weight heparin for DVT prevention. Seven patients (14%) developed DVT confirmed by triplex examination: one on day 4, three on day 7, one on day 14, one on day 16 and one on day 23. All of them had a femoral CVC on the side of thrombosis on the confirmation of DVT. None of them developed pulmonary embolism investigated by a thorax spiral computerised tomography. None of them died due to pulmonary embolism. Of the remaining 43 patients, 37 experienced a femoral CVC during hospitalization. The mean duration of femoral CVC stay was 8.0 ± 1.5 in patients who developed DVT and 6.5 ± 0.5 for patients that did not develop DVT (P > 0.05). The relative risk for developing DVT in the presence of a femoral CVC was 1.2 (confidence interval 1.04–1.3).

Conclusions

DVT may develop in critically ill patients, which may be related to the presence of a femoral CVC. Other sides for CVC placement should be preferred if possible for the prevention of DVT, especially in predisposed patients.