PURPOSE: The purpose of this study was to evaluate 1) The incidence, risk factors and characteristics associated with upper extremity deep venous thrombosis (UE DVT); and 2) To look at the current treatments used for UE DVT and side effects of treatment in our Critically Ill surgical patient population.
METHODS: A retrospective chart review was performed on total of 68 subjects who were admitted to the surgical intensive care unit (ICU), during the period of January 2004 through March 2005 (15 months), and were diagnosed with upper extremity deep venous thrombosis.
RESULTS: The incidence was 2.7%. There were 34 males and 34 females, with a mean age of 61 years (Range 18 –91 years; std dev 16.2). Swelling of the extremity was the most common symptom (79.4%). Central Venous catheter was the most frequently associated risk factor (67/68); median line days were 19. Varied practices of anti-coagulation were observed. A combination of heparin and coumadin was used most frequently(20/60). The incidence of major bleeding complications leading to discontinuation of therapy and/or exploration for bleeding was 20.5% (14/68). Three subjects developed pulmonary embolism while on active anti-coagulation. Resource utilization was more if the DVT was diagnosed while in the ICU [Median ICU stay 21 vs 3 days (p<0.0001), Median Hospital Stay 35 vs 15 days (p<0.001)].
CONCLUSION: In conclusion, upper extremity DVT when diagnosed in Surgical ICU is an independent predictor of source utilization, and treatment needs to be monitored carefully as major bleeding complications are a major concern.
CLINICAL IMPLICATIONS: Upper extremity DVT can be a significant problem regarding access in critically ill surgical patients who may require long term parentreral nutrition and intravenous antibiotic therapy. Major bleeding complications as seen in this study may limit anti-coagulation in the immediate post-operative period. These factors may increase resource utilization in the ICU.
DISCLOSURE: Namrata Patil, No Financial Disclosure Information; No Product/Research Disclosure Information