90990
document
Lower extremity deep vein thrombosis : a prospective , randomized , controlled trial in comatose or sedated patients undergoing femoral vein catheterization . OBJECTIVES To determine the rate of lower extremity deep vein thrombosis after the use of femoral catheters in intensive care unit ( ICU ) comatose or sedated adults . Results were then compared with results of patients undergoing superior vena cava catheterization . DESIGN Prospective , randomized , controlled , unblinded study . SETTING A mixed medical/surgical ICU in a university hospital . PATIENTS Sixty-one comatose or sedated patients admitted to the ICU who underwent central venous catheterization . INTERVENTIONS Patients were monitored for signs of thrombotic complications . On catheter removal , a lower-extremity bilateral phlebographic examination was performed in each patient . MEASUREMENTS AND MAIN RESULTS After randomization , 31 patients underwent femoral vein catheterization and 30 patients underwent superior vena cava catheterization , either by axillary ( 21 patients ) or internal jugular vein ( 10 patients ) cannulation . Single lumen polyurethane catheters were inserted for a mean duration of 7.1 +/- 4.6 ( SD ) days in the femoral vein group and 9.9 +/- 5.5 days in the superior vena cava group ( p = NS ) . No patient had clinical signs of leg venous thrombosis or pulmonary embolism during the study period . In each patient , lower extremity bilateral phlebography was performed at the time of catheter removal . Leg phlebographies were normal in 18 ( 60 % ) patients in the femoral vein group and 26 ( 84 % ) patients in the superior vena cava group . Fibrin sleeves which developed around the femoral catheters were seen in seven ( 23.3 % ) patients in the femoral vein group and in no patients in the superior vena cava cannulation group . Three patients had femoral vein thrombosis , two ( 6.6 % ) patients in the femoral vein group ( two nonobstructive thromboses , adherent to the common femoral vein wall ) and one ( 3.0 % ) patient in the superior vena cava group ( nonobstructive thrombosis which developed in the superficial femoral vein ) ( p = NS ) . Lower deep extremities thrombosis developed in five ( 16.7 % ) patients in the femoral vein group and in five ( 16 % ) patients in the superior vena cava group ( p = NS ) . CONCLUSIONS Femoral vein catheterization with a polyurethane catheter is associated with a lower rate of extremity deep vein thrombosis which is similar to the rate observed after superior vena cannulation in comatose or sedated patients . Femoral vein thrombosis was observed at a rate of 6.6 % after femoral vein cannulation and a rate of 3 % after superior vena cava cannulation . Given the acceptable rate of this clinically important complication , femoral vein cannulation offers an attractive alternative to insertion via the vena cava in the critically ill .
90991
Intervention_Surgical
femoral vein catheterization
90992
Intervention_Physical
femoral catheters
90993
Intervention_Surgical
superior vena cava catheterization
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Intervention_Surgical
central venous catheterization
90995
Intervention_Surgical
femoral vein catheterization
90996
Intervention_Surgical
superior vena cava catheterization
90997
Intervention_Physical
Single lumen polyurethane catheters
90998
Intervention_Surgical
femoral vein group
90999
Intervention_Physical
superior vena cava
91000
Intervention_Physical
lower extremity bilateral phlebography
91001
Intervention_Physical
femoral vein
91002
Intervention_Physical
superior vena cava cannulation
91003
Intervention_Physical
femoral vein
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Intervention_Physical
superior vena cava
91005
Intervention_Surgical
Femoral vein catheterization
91006
Intervention_Surgical
femoral vein cannulation
91007
Intervention_Surgical
superior vena cava cannulation
91008
Intervention_Surgical
femoral vein cannulation
91009
Intervention_Physical
vena cava
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Outcome_Physical
Lower extremity deep vein thrombosis :
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Outcome_Physical
rate of lower extremity deep vein thrombosis
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Outcome_Physical
thrombotic complications .
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Outcome_Physical
leg venous thrombosis
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Outcome_Physical
pulmonary embolism
91015
Outcome_Physical
lower extremity bilateral phlebography
91016
Outcome_Physical
Leg phlebographies
91017
Outcome_Physical
Fibrin sleeves
91018
Outcome_Physical
femoral vein thrombosis
91019
Outcome_Physical
Lower deep extremities thrombosis
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Outcome_Physical
rate of extremity deep vein thrombosis
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Outcome_Physical
Femoral vein thrombosis
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Participant_Condition
comatose or sedated patients undergoing femoral vein catheterization .
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Participant_Sample-size
Sixty-one
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Participant_Sample-size
31
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Participant_Sample-size
30
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Participant_Sample-size
21