Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis

A prospective analysis of 2,128 catheter days in the surgical intensive care unit

Darren Malinoski, Tyler Ewing, Akash Bhakta, Randi Schutz, Bryan Imayanagita, Tamara Casas, Noah Woo, Daniel Margulies, Cristobal Barrios, Michael Lekawa, Rex Chung, Marko Bukur, Allen Kong

    Research output: Contribution to journalArticle

    21 Citations (Scopus)

    Abstract

    BACKGROUND: Catheter-associated deep venous thromboses (CADVTs) are a common occurrence in the surgical intensive care unit (SICU), necessitating central venous catheter (CVC) removal and replacement. Previous studies evaluating risk factors for CADVT in SICU patients are limited, and most lack a true denominator of all CVC days.We sought to determine the true incidence of and risk factors for CADVT based on patient characteristics as well as CVC site, type, and duration of insertion. METHODS: The following data from all SICU patients in two urban Level I trauma centerswere prospectively collected from 2009 to 2012: demographics, risk factors for DVT, CVC site/type/duration, and duplex results. Sites included the subclavian (SC), internal jugular (IJ), arm (for peripherally inserted central catheter [PICC] lines), and femoral. Types included multilumen (ML), introducer/hemodialysis (I/HD), and PICC. High-risk patients received weekly screening duplex examinations and a CADVT was defined as a DVT being detected on duplex with a CVC in place or within 7 days of removal. Rates of CADVT were normalized per 1,000 CVC days, and independent predictors of CADVT were determined using logistic regression. RESULTS: Data were complete for 184 patients, 354 CVCs, and 2,128 CVC days. Fifty-nine CADVTs were diagnosed in 28% of patients. Rates of CADVTwere 9 per 1,000 catheter days for SC, 61 for IJ (p <0.01 vs. SC), 27 for arm (p <0.01), 36 for femoral (p <0.01), 22 for ML, 57 for I/HD (p <0.01 vs. ML), and 27 for PICC (p = 0.24). After adjusting for patient risk factors, predictors of CADVTincluded the IJ and arm sites (odds ratio, 6.0 and 3.0 compared with SC) and the I/HD type (odds ratio, 2.6 compared with ML, all p <0.05). CONCLUSION: The IJ and arm sites and I/HD type are associated with increased CADVT. These data may be used to determine the optimal site and type of CVC for insertion.

    Original languageEnglish (US)
    Pages (from-to)454-462
    Number of pages9
    JournalJournal of Trauma and Acute Care Surgery
    Volume74
    Issue number2
    DOIs
    StatePublished - Feb 2013

    Fingerprint

    Central Venous Catheters
    Critical Care
    Venous Thrombosis
    Intensive Care Units
    Catheters
    Renal Dialysis
    Neck
    Thigh
    Odds Ratio
    Logistic Models
    Demography

    Keywords

    • Catheter-associated deep venous thrombosis
    • Central venous catheter
    • Critical care
    • Risk factors

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis : A prospective analysis of 2,128 catheter days in the surgical intensive care unit. / Malinoski, Darren; Ewing, Tyler; Bhakta, Akash; Schutz, Randi; Imayanagita, Bryan; Casas, Tamara; Woo, Noah; Margulies, Daniel; Barrios, Cristobal; Lekawa, Michael; Chung, Rex; Bukur, Marko; Kong, Allen.

    In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 2, 02.2013, p. 454-462.

    Research output: Contribution to journalArticle

    Malinoski, Darren ; Ewing, Tyler ; Bhakta, Akash ; Schutz, Randi ; Imayanagita, Bryan ; Casas, Tamara ; Woo, Noah ; Margulies, Daniel ; Barrios, Cristobal ; Lekawa, Michael ; Chung, Rex ; Bukur, Marko ; Kong, Allen. / Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis : A prospective analysis of 2,128 catheter days in the surgical intensive care unit. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 2. pp. 454-462.
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    abstract = "BACKGROUND: Catheter-associated deep venous thromboses (CADVTs) are a common occurrence in the surgical intensive care unit (SICU), necessitating central venous catheter (CVC) removal and replacement. Previous studies evaluating risk factors for CADVT in SICU patients are limited, and most lack a true denominator of all CVC days.We sought to determine the true incidence of and risk factors for CADVT based on patient characteristics as well as CVC site, type, and duration of insertion. METHODS: The following data from all SICU patients in two urban Level I trauma centerswere prospectively collected from 2009 to 2012: demographics, risk factors for DVT, CVC site/type/duration, and duplex results. Sites included the subclavian (SC), internal jugular (IJ), arm (for peripherally inserted central catheter [PICC] lines), and femoral. Types included multilumen (ML), introducer/hemodialysis (I/HD), and PICC. High-risk patients received weekly screening duplex examinations and a CADVT was defined as a DVT being detected on duplex with a CVC in place or within 7 days of removal. Rates of CADVT were normalized per 1,000 CVC days, and independent predictors of CADVT were determined using logistic regression. RESULTS: Data were complete for 184 patients, 354 CVCs, and 2,128 CVC days. Fifty-nine CADVTs were diagnosed in 28{\%} of patients. Rates of CADVTwere 9 per 1,000 catheter days for SC, 61 for IJ (p <0.01 vs. SC), 27 for arm (p <0.01), 36 for femoral (p <0.01), 22 for ML, 57 for I/HD (p <0.01 vs. ML), and 27 for PICC (p = 0.24). After adjusting for patient risk factors, predictors of CADVTincluded the IJ and arm sites (odds ratio, 6.0 and 3.0 compared with SC) and the I/HD type (odds ratio, 2.6 compared with ML, all p <0.05). CONCLUSION: The IJ and arm sites and I/HD type are associated with increased CADVT. These data may be used to determine the optimal site and type of CVC for insertion.",
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    author = "Darren Malinoski and Tyler Ewing and Akash Bhakta and Randi Schutz and Bryan Imayanagita and Tamara Casas and Noah Woo and Daniel Margulies and Cristobal Barrios and Michael Lekawa and Rex Chung and Marko Bukur and Allen Kong",
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    T1 - Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis

    T2 - A prospective analysis of 2,128 catheter days in the surgical intensive care unit

    AU - Malinoski, Darren

    AU - Ewing, Tyler

    AU - Bhakta, Akash

    AU - Schutz, Randi

    AU - Imayanagita, Bryan

    AU - Casas, Tamara

    AU - Woo, Noah

    AU - Margulies, Daniel

    AU - Barrios, Cristobal

    AU - Lekawa, Michael

    AU - Chung, Rex

    AU - Bukur, Marko

    AU - Kong, Allen

    PY - 2013/2

    Y1 - 2013/2

    N2 - BACKGROUND: Catheter-associated deep venous thromboses (CADVTs) are a common occurrence in the surgical intensive care unit (SICU), necessitating central venous catheter (CVC) removal and replacement. Previous studies evaluating risk factors for CADVT in SICU patients are limited, and most lack a true denominator of all CVC days.We sought to determine the true incidence of and risk factors for CADVT based on patient characteristics as well as CVC site, type, and duration of insertion. METHODS: The following data from all SICU patients in two urban Level I trauma centerswere prospectively collected from 2009 to 2012: demographics, risk factors for DVT, CVC site/type/duration, and duplex results. Sites included the subclavian (SC), internal jugular (IJ), arm (for peripherally inserted central catheter [PICC] lines), and femoral. Types included multilumen (ML), introducer/hemodialysis (I/HD), and PICC. High-risk patients received weekly screening duplex examinations and a CADVT was defined as a DVT being detected on duplex with a CVC in place or within 7 days of removal. Rates of CADVT were normalized per 1,000 CVC days, and independent predictors of CADVT were determined using logistic regression. RESULTS: Data were complete for 184 patients, 354 CVCs, and 2,128 CVC days. Fifty-nine CADVTs were diagnosed in 28% of patients. Rates of CADVTwere 9 per 1,000 catheter days for SC, 61 for IJ (p <0.01 vs. SC), 27 for arm (p <0.01), 36 for femoral (p <0.01), 22 for ML, 57 for I/HD (p <0.01 vs. ML), and 27 for PICC (p = 0.24). After adjusting for patient risk factors, predictors of CADVTincluded the IJ and arm sites (odds ratio, 6.0 and 3.0 compared with SC) and the I/HD type (odds ratio, 2.6 compared with ML, all p <0.05). CONCLUSION: The IJ and arm sites and I/HD type are associated with increased CADVT. These data may be used to determine the optimal site and type of CVC for insertion.

    AB - BACKGROUND: Catheter-associated deep venous thromboses (CADVTs) are a common occurrence in the surgical intensive care unit (SICU), necessitating central venous catheter (CVC) removal and replacement. Previous studies evaluating risk factors for CADVT in SICU patients are limited, and most lack a true denominator of all CVC days.We sought to determine the true incidence of and risk factors for CADVT based on patient characteristics as well as CVC site, type, and duration of insertion. METHODS: The following data from all SICU patients in two urban Level I trauma centerswere prospectively collected from 2009 to 2012: demographics, risk factors for DVT, CVC site/type/duration, and duplex results. Sites included the subclavian (SC), internal jugular (IJ), arm (for peripherally inserted central catheter [PICC] lines), and femoral. Types included multilumen (ML), introducer/hemodialysis (I/HD), and PICC. High-risk patients received weekly screening duplex examinations and a CADVT was defined as a DVT being detected on duplex with a CVC in place or within 7 days of removal. Rates of CADVT were normalized per 1,000 CVC days, and independent predictors of CADVT were determined using logistic regression. RESULTS: Data were complete for 184 patients, 354 CVCs, and 2,128 CVC days. Fifty-nine CADVTs were diagnosed in 28% of patients. Rates of CADVTwere 9 per 1,000 catheter days for SC, 61 for IJ (p <0.01 vs. SC), 27 for arm (p <0.01), 36 for femoral (p <0.01), 22 for ML, 57 for I/HD (p <0.01 vs. ML), and 27 for PICC (p = 0.24). After adjusting for patient risk factors, predictors of CADVTincluded the IJ and arm sites (odds ratio, 6.0 and 3.0 compared with SC) and the I/HD type (odds ratio, 2.6 compared with ML, all p <0.05). CONCLUSION: The IJ and arm sites and I/HD type are associated with increased CADVT. These data may be used to determine the optimal site and type of CVC for insertion.

    KW - Catheter-associated deep venous thrombosis

    KW - Central venous catheter

    KW - Critical care

    KW - Risk factors

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