Study objectives: To determine the frequency of and
potential risk factors for catheter-related deep venous thrombosis
(DVT) in critically ill adult patients.
Prospective, controlled, observational cohort study.
Setting: A mixed medical and surgical ICU in a university
Patients: All adult patients undergoing
femoral vein catheterization.
Measurements: ICU diagnosis, underlying disease,
demographic data, type of catheter, complications during cannulation,
use of anticoagulants, coagulation status, medications infused, and
duration of catheterization were recorded. Compression and duplex
Doppler ultrasound studies of both femoral veins were performed prior
to insertion, at 12 h after insertion, and daily until catheter
removal. Follow-up investigation was performed at 24 h and 1 week
Results: Of 140 cases entered into the
study, 124 were evaluated. Fourteen patients developed iliofemoral vein
DVTs. Two were clinically obvious. Twelve (9.6%) were line related
(uncannulated leg normal) and two (1.6%) occurred only in the
uncannulated 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 after
insertion to 1 week after removal. The incidence of catheter-related
DVT was unrelated to number of insertion attempts, arterial puncture or
hematoma, duration of catheterization, coagulation status, or type of
infused medications. No other predisposing or protective factors were
identified. Three of the 12 patients with catheter-related DVT died. In
no patient was clinical pulmonary embolus suspected.
Conclusion: Although the femoral route is convenient and
has potential advantages, the use of femoral lines increases the risk
of iliofemoral DVT. Catheter-related DVT may occur as soon as 1 day
after cannulation and is usually asymptomatic. This increased risk
should be carefully considered when the femoral route of cannulation is