Bedside placement of inferior vena cava filters in the intensive care unit

The objective of this study was to determine the feasibility, cost-effectiveness, and complications of bedside placement of inferior vena cava (IVC) filters in the intensive care unit (ICU) in the trauma patient. A prospective trial involving 25 trauma patients admitted to Memorial Regional Hospital (Hollywood, Florida), a Level I trauma center, from April 1997 to April 1998, meeting the criteria for insertion of a prophylactic IVC filter according to Eastern Association for the Surgery of Trauma trauma practice guidelines was conducted. IVC filters were placed in the ICU with the use of a digital C-arm (Siemens) and strict adherence to sterile technique. Renal vein anatomy and size of the IVC were documented for every case. Charges for equipment and supplies were analyzed and compared with those placed in the radiology suite and the operating room. Of 810 patients admitted as trauma alerts during the study period, 25 had an IVC filter placed at the bedside in the ICU. The indications for filter placement included a contraindication to anticoagulation and one of the following: severe pelvic fracture and/or associated long-bone fracture (32%); bilateral lower extremity fractures (28%); spinal cord injury with para- or quadriplegia (16%); femoral vein thrombosis (16%); and severe brain injury (8%). There were no intraoperative nor postoperative complications; overall mortality was 20 per cent, unrelated to the IVC filter placement. Average time for insertion was 47 minutes for the series and 20 minutes for the last five cases. Savings of $1844 or $2245 per filter are obtained when IVC filters are placed in the ICU when compared with the operating room or radiology suite, respectively. Bedside placement of IVC filters in the ICU is a safe, cost-effective method that can be performed without compromising the patient and avoids the potential disasters involved in transporting critically ill patients.