Duplex directed caval filter insertion in multi-trauma and critically ill patients

Area of Science:

• Medical procedures
• Critical care medicine
• Vascular interventions

Background:

• Inferior vena cava (IVC) filters are crucial for preventing pulmonary embolism in high-risk patients.
• Traditional filter placement often requires transport to specialized imaging suites.
• Critically ill and multi-trauma patients present unique challenges for invasive procedures.

Purpose of the Study:

• To assess the safety and feasibility of bedside IVC filter insertion using duplex imaging.
• To evaluate the efficacy of duplex-directed caval filter (DDCF) placement in intensive care unit (ICU) patients.
• To determine the success rate of bedside IVC filter procedures in a multi-trauma population.

Main Methods:

• Prospective evaluation of 53 multi-trauma/critically ill patients requiring IVC filters.
• Bedside IVC filter insertion using Vena Tech filters under duplex ultrasonography guidance.
• Screening IVC duplex scans performed to ensure satisfactory visualization prior to attempted DDCF insertion.

Main Results:

• Successful duplex visualization of the IVC was achieved in 85% (45/53) of patients.
• DDCF insertion was attempted in 87% (46/53) of patients with satisfactory visualization.
• Bedside insertion was demonstrated to be safe, rapid, and effective in this patient cohort.

Conclusions:

• Bedside IVC filter insertion guided by duplex imaging is a safe and feasible option for critically ill patients.
• This technique significantly reduces procedural costs and avoids patient transport, radiation, and contrast media.
• Duplex ultrasonography is a reliable tool for guiding IVC filter placement at the bedside when visualization is adequate.