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Published on: December 23, 2014
Upper-extremity deep vein thrombosis after central venous catheterization via the axillary vein
1Department of Anesthesia and Intensive Care, Hôpital Sainte-Marguerite, Marseilles University Hospital System, Marseilles School of Medicine, France.
Insights
Axillary vein catheterization leads to an 11.6% rate of upper-extremity deep vein thrombosis, similar to other central venous catheter sites. Limiting catheter dwell time to under two weeks may reduce this risk.
Area of Science:
- Vascular Surgery
- Critical Care Medicine
- Radiology
Background:
- Central venous catheterization is essential for critically ill patients.
- Axillary vein catheterization is an alternative to internal jugular or subclavian approaches.
- The risk of thrombosis associated with axillary vein catheterization requires investigation.
Purpose of the Study:
- To determine the frequency of central venous catheter-induced thrombosis of the axillary vein.
- To compare the incidence of deep vein thrombosis in catheterized versus uncatheterized arms.
- To evaluate the association between catheter dwell time and thrombosis risk.
Main Methods:
- Prospective, controlled study at a tertiary care university center.
- Sixty intensive care unit patients underwent axillary vein catheterization.
- Phlebographic examination was performed on catheter removal to assess for deep vein thrombosis.
Main Results:
- Axillary vein catheterization was associated with an 11.6% frequency of upper-extremity deep vein thrombosis.
- Thrombosis was significantly less frequent with catheter dwell times under 15 days (p < .01).
- No pulmonary embolism was clinically observed.
Conclusions:
- Axillary vein catheterization presents an acceptable risk of deep vein thrombosis, comparable to other central venous sites.
- Axillary vein catheterization is a viable alternative for critically ill patients.
- Limiting axillary catheter dwell time to a maximum of two weeks is recommended to minimize thrombosis risk.
Objective:
To determine the frequency of central venous catheter-induced thrombosis of the axillary vein.
Design:
Prospective, controlled study.
Setting:
Tertiary care university center.
Patients:
Sixty patients in a medical-surgical intensive care unit who required central venous catheterization via the axillary vein.
Interventions:
Single-lumen, silicone elastomer or polyurethane catheters were inserted for a mean duration of 14.7+/-7.4 days (range, 4-33 days). On catheter removal, bilateral upper-extremity phlebographic examination was performed in each patient. The incidence of deep vein thrombosis in catheterized arms was compared with that in uncatheterized arms.
Measurements And Main Results:
Of the 60 patients who underwent axillary vein cannulation, one patient had clinical signs of arm vein thrombosis, but no patient had clinical sign of pulmonary embolism. There were 35 patients (58.3%) who developed positive phlebographic examinations homolateral to the catheter. Fibrin sleeves that developed around the catheters were observed in 28 patients (47%). Five patients (8.3%) had phlebographic signs of partial axillary vein thrombosis: nonobstructive clots adherent to the vessel wall and/or the catheter. Two patients (3.3%) had phlebographic signs of complete axillary vein thrombosis. No thrombosis was observed in patients with catheterizations lasting < or =6 days, two cases were observed for duration of 7-14 days, and five cases were observed for duration of > or =15 days (p < .01). In the seven patients with axillary vein thrombosis, the vessel was cannulated with fewer than three puncture attempts, and the mean duration for catheter insertion (10+/-2.5 min) was not different from that of patients with no axillary vein thrombosis (14+/-9 min).
Conclusions:
Based on the data from the present study, we conclude that axillary vein catheterization is associated with a 11.6% frequency of upper-extremity deep vein thrombosis. This rate of vein thrombosis is similar to that observed after internal jugular or subclavian vein cannulation. Given the acceptable rate of this clinically important complication, axillary vein cannulation offers an attractive alternative site for catheter insertion to the internal jugular or subclavian vein in the critically ill. Because thrombosis is rare or absent in catheterizations lasting <15 days, it seems wise to withdraw axillary catheters after a maximum of 2 wks.
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