Central line associated venous thrombosis in adult trauma intensive care units

Central venous catheter thrombosis (CRT) is a common entity in critical care units with incidence between 1.9% and 44%. The incidence of venous thromboembolism reaches to 14–59% in high risk trauma patients without thromboprophylaxis and 3.6–33% for those receiving prophylaxis. The majority of thrombotic events are asymptomatic or obscured by other pathologies in trauma patients so screening bedside ultrasonography may play a significant role in detection of thrombosis and related complications. The aim of this study was to evaluate the prevalence of catheter related venous thrombosis with Doppler sonography in adult trauma patients admitted in ICUs. Patients and methods With the aid of duplex ultrasonography we prospectively evaluated 82 adult intensive care unit trauma patients for the incidence of central venous thrombosis in four time points. Demographic data, as well as the location of the catheter, anticoagulant prescription during ICU stay, smoking habits, aspirin consumption were recorded beside other probable contributing factors for thrombosis. Results Nine patients had CRT during study period, of which 8 patients had internal jugular catheters and one had femoral catheter. There was no evidence of thrombosis in any patient with subclavian catheter. The use of aspirin, smoking, subclavian catheter were associated with reduced CRT incidence. In contrast, internal Jugular catheter and catheterization for over 7 days, was associated with an increased CRT incidence. Heparin and enoxaparin had no effect on CRT Conclusions Ultrasound as a non-invasive, readily available and easy to use bedside tool is an appropriate diagnostic method for central catheter related thrombosis in ICU trauma patients. In this patient population, subclavian catheters are associated with lower risk of thrombossis than internal jugular and femoral sites. Catheter day longer than 3 day was also associated with greater risk of CRT.