C Martin1, X Viviand, P Saux, F Gouin. 1. Department of Anesthesia and Intensive Care, Hôpital Sainte-Marguerite, Marseilles University Hospital System, Marseilles School of Medicine, France.
Abstract
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.
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.
Authors: Ana T Rocha; Edison F Paiva; Arnaldo Lichtenstein; Rodolfo Milani; Cyrillo Filho Cavalheiro; Francisco H Maffei Journal: Vasc Health Risk Manag Date: 2007
Authors: Joel G Ray; Loralie J Langman; Marian J Vermeulen; Jovan Evrovski; Erik L Yeo; David EC Cole Journal: Curr Control Trials Cardiovasc Med Date: 2001
Authors: Marco Cascella; Marco Mc Cascella; Manuela Arcamone; Manuela Ma Arcamone; Emanuela Morelli; Emanuela Em Morelli; Daniela Viscardi; Daniela Dv Viscardi; Viera Russo; Viera Vr Russo; Silvia De Franciscis; Silvia Sdf De Franciscis; Andrea Belli; Andrea Ab Belli; Rosanna Accardo; Rosanna Ra Accardo; Domenico Caliendo; Domenico Dc Caliendo; Elena De Luca; Elena Edl De Luca; Barbara Di Caprio; Barbara Bdc Di Caprio; Francesco Di Sauro; Francesco Fds Di Sauro; Giovanni Giannoni; Giovanni Gg Giannoni; Carmine Iermano; Carmine Ci Iermano; Maria Maciariello; Maria Mm Maciariello; Marcella Marracino; Marcella Mm Marracino; Arturo Cuomo; Arturo Ac Cuomo Journal: J Med Case Rep Date: 2015-08-20