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Macro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy study
Mika M Rockholt1,2,3, Leila Naddi1,3, Ahmed M Badri1,4
1Department of Intensive and Perioperative Care, Skåne University Hospital, 221 85, Lund, Sweden.
Insights
Catheter-related thrombosis and vein wall changes are common even with short-term use of centrally inserted central catheters (CICCs). These findings highlight potential risks like pulmonary embolism and chronic venous stenosis.
Area of Science:
- Vascular Medicine
- Pathology
- Medical Devices
Background:
- Centrally inserted central catheters (CICCs) are essential in healthcare but associated with complications.
- Catheter-related thrombosis occurs in 5-30% of CICC patients.
- Limited data exists on thrombosis incidence with ultrasound-guided CICC insertion.
Purpose of the Study:
- To investigate macro- and microscopic changes in vein walls related to CICCs.
- To assess the incidence of catheter-related thrombosis post-ultrasound guidance.
Main Methods:
- Autopsy study of 12 patients with short-term CICCs.
- Macroscopic and microscopic examination of vessels with inserted catheters.
- Ethical approval obtained from the Swedish Ethical Review Authority.
Main Results:
- All 12 patients (100%) showed thrombi attached to the catheter or vessel wall.
- Inflammatory changes were present in all cases (100%).
- Fibrosis of the vessel wall was observed in 67% of cases.
Conclusions:
- Catheter-related thrombus formation and vein wall thickening are frequent, even with short CICC duration.
- Findings suggest risks of pulmonary embolism, catheter-related infections, and chronic venous stenosis.
- Complications may be masked by underlying diseases necessitating CICC placement.
Background:
Centrally inserted central catheters (CICCs) are indispensable in modern healthcare, but unfortunately, come with complications. Catheter-related thrombosis is a well-known complication reported to occur in 5-30% of patients with CICC. There is a paucity of studies that report the incidence of catheter-related thrombosis after the introduction of real-time ultrasound insertion guidance as clinical practice. This study aimed to demonstrate any pathological macro- or microscopic changes in the vein wall associated with CICCs.
Methods:
The study was approved by the Swedish Ethical Review Authority and was conducted at a large university hospital. The study included 12 patients with a short-term CICC who were subject to autopsies. Vessels with inserted catheters were macroscopically and microscopically examined.
Results:
In total, seven female and five male patients with a median age of 70 (interquartile range 63-76) were included. With one exception, all patients received routine thromboprophylaxis throughout the period with CICC. Most inserted CICCs were 9.5 French (54%) and were inserted in the internal jugular vein (92%). The median time with CICC was seven days (interquartile range 1.8-20). At autopsy, thrombi were observed in all cases (100%), macroscopically and microscopically, attached to the distal portion of the CICC and/or the adjacent vessel wall. Inflammatory changes in the vessel walls were seen in all cases, and varying degrees of fibrosis were demonstrated in eight cases (67%).
Conclusions:
This autopsy study demonstrated that catheter-related thrombus formation with adjacent inflammatory and fibrotic vessel wall thickening was very common, despite a limited period of catheter use. The consequences of these findings are important, as thrombi may cause pulmonary embolism and possibly lead to catheter-related infections, and since inflammatory and fibrotic vessel wall thickening may evolve into chronic venous stenosis. Furthermore, the findings are a cause of concern, as CICCs are indispensable in modern healthcare and complications may be masked by the general disease that was the indication for CICC insertion.
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