Prolonged use of indwelling central venous catheters is increasing in both inpatient and outpatient settings with infection and thrombosis constituting the major complications. While recommendations regarding prevention of catheter thrombosis have been established for dialysis and cancer patients, data regarding prevention in others remains largely anecdotal. Our goal was to better quantify the incidence of thrombosis and other complications in patients with indwelling central catheters in an attempt to evaluate the potential clinical value of prophylactic anticoagulation.
A retrospective chart review of patient records from 1991-2002 with ICD-9 coding for central venous catheter placement. Patients included had catheters in place for greater than 5 days and were not on anticoagulation. Patients with chronic renal failure, malignancy, sickle cell disease, acute thrombotic event within the past six months, or other known hypercoagulable state were excluded. Data was abstracted to include type and position of catheter, its primary use, number of days in place and associated complications.
Of 874 charts reviewed, 252 patients met inclusion criteria.Line type: Triple lumen catheters 217 (86%), Peripherally Inserted Central Catheters 35 (14%)Location: Arm 35 (14%), Femoral 32 (13%), Subclavian 64 (25%), Internal Jugular 121 (48%)Placed by Radiology 32 (13%), Medicine 115 (46%), Surgery 65 (26%), Anesthesiology 38 (15%), Nursing 2 (<1%)Primary Line use: antibiotics 87, nutrition 34, other medications 126, acute dialysis 5Days indwellling: 5-9 = 175, 10-14 = 43, 15-19 = 14, 20-24 = 10, 25-30 = 6, greater than 30 = 4Complications: None in 218 (87%), confirmed or suspected infection 26 (10%), suspected thrombosis 5 (0.2%), confirmed thrombosis 0, pneumothorax 7 (0.3%)CONCLUSIONS: While infection was the most common complication, our study did not show a significant number of thrombotic complications in patients with long term indwelling catheters.
Adults without a diagnosis of malignancy or other known hypercoaguable state may safely utilize central venous catheters without prophylactic anticoagulation.
R.L. Shriver, None.