Education, Research, and Quality Improvement |

Barriers to IVC Retrieval at a Community Teaching Hospital FREE TO VIEW

Thanhtaik Kyaw*, MD; Ravindra Rajmane, MD; Luis Junco, MD; Nandini Menon, BS; Jessica Camponova, BS; Gao Wenli, MD
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New York Downtown Hospital, New York, NY

Chest. 2012;142(4_MeetingAbstracts):546A. doi:10.1378/chest.1390702
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SESSION TYPE: Outcomes/Quality Control Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Harm from IVC filter placement has been increasingly documented such as erosion through the vena cava wall, filter thrombosis, and filter migration. Retrievable IVC filters provide the option of removing the device once the risks for propagation of venous thromboembolism has subsided. Yet protocols for IVC filter monitoring and potential retrieval have not been fully developed at our teaching community hospital. We analyze all indications for IVC filter placement at our institution, barriers to follow up, and potential complications associated with the device.

METHODS: A retrospective random chart review of the medical records from 02/2005 to 06/2011 was conducted at an urban hospital.

RESULTS: A total of 74 charts were reviewed, which include 37 men and 37 women. Most of the patients (64%) were over the age of 70 and only 11% were younger than 50. 58.1% had retrievable IVC filter placement and remaining were permanent. The most common indication for IVC filter placement was contraindication to anticoagulation in the setting of a diagnosis of either pulmonary embolism (PE) or deep vein thrombosis (DVT). Retrievable IVC filters were predominately placed for patients who did not present on admission with VTE. Only 33.7% of our patients had admitting diagnosis of either PE or DVT. The majority of patients were found to have either DVT or PE during the hospital stay after admission for a non VTE diagnosis. Most common barriers to follow up were attributed to i. language (37%), ii. co-morbid disease (21%) and iii. death (21%). 36 patients (48%) were non-English speaking and 21% had end stage malignancy. Among patients with retrievable IVC filter placed, 18% were retrieved and 21% died within 2 weeks from underlying severe medical illness.

CONCLUSIONS: The overall documented monitoring and retrieval rate for IVC filters for our institution for 52 months is 18%. Barriers to IVC filter retrieval in our study are due to language , co-morbid disease and early death.

CLINICAL IMPLICATIONS: Effective protocols to monitor IVC filter complications must be readily available in the patients’ language. Well delineated protocols for follow up are necessary in order to document potential complications and plan for device retrieval. Despite the increasingly widespread use of retrievable IVC filter placement, our study suggests that patients expected to die or with severe co-morbid diseases should have permanent IVC filters placed.

DISCLOSURE: The following authors have nothing to disclose: Thanhtaik Kyaw, Ravindra Rajmane, Luis Junco, Nandini Menon, Jessica Camponova, Gao Wenli

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New York Downtown Hospital, New York, NY




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