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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Insertion of central venous catheters induces a hypercoagulable state
Mark L Ryan1, Chad M Thorson, David R King
1Division of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami School of Medicine, Ryder Trauma Center, Miami, Florida 33136, USA.
The Journal of Trauma and Acute Care Surgery
|August 1, 2012
Summary
Central venous catheter (CVC) insertion triggers a hypercoagulable state in both swine and critically ill patients, potentially explaining increased venous thromboembolism risk. This response was prevented by enoxaparin in animals.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Critical Care Medicine
Background:
- Central venous catheters (CVCs) are associated with an increased risk of venous thromboembolism (VTE).
- Previous studies indicated pulmonary artery catheters induce a hypercoagulable state.
- The current study investigates if CVC insertion elicits a similar hypercoagulable response.
Purpose of the Study:
- To determine if central venous catheter insertion is associated with a hypercoagulable state.
- To compare the hypercoagulable response in an animal model (swine) and human patients.
Main Methods:
- Healthy anesthetized swine (N=16) and critically ill human patients (N=8) underwent central venous catheter insertion.
- Serial arterial blood samples were analyzed using kaolin-activated thromboelastography (TEG) before and after CVC placement.
- Routine and special coagulation tests were performed on human samples.
Main Results:
- CVC insertion significantly decreased TEG clotting time (R) and clot formation time (K) in both swine and humans.
- Fibrin cross-linking (α) was accelerated in swine and humans, though overall clot strength (maximum amplitude) remained unaffected.
- No changes were observed in routine coagulation factors; the hypercoagulable response in animals was prevented by enoxaparin.
Conclusions:
- Central venous catheter insertion induces a systemic hypercoagulable state in both healthy swine and critically ill patients.
- This induced hypercoagulability may contribute to the increased risk of venous thromboembolism associated with CVCs.
- Further research is needed to elucidate the precise mechanisms underlying this response due to small sample size limitations.
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