Deep venous thrombosis and femoral catheters

Purpose: To evaluate the incidence of deep venous thrombosis (DVT) associated with femoral catheters and compare central venous pressures obtained from femoral catheters and superior vena cava (SVC) catheters in critically ill patients. Methods: Doppler ultrasound examinations of both legs were performed prior to catheterization and every 48 hours thereafter, for the duration of the catheterization in 27 patients. The non-catheterized leg acted as a control. Central venous presure measurements were compared in patients with co-existing SVC and femoral catheters. Results: There were 30 femoral catheters (11 triple lumen, 12 dialysis, 7 [8.5 Fr.] introducer) placed in 27 patients by residents (18), fellows (10) and staff physicians (2). No insertion complications were noted. Catheter-associated DVT was detected in 8 patients. Two patients developed DVT shortly after catheter removal. Only one catheter-associated DVT was evident from physical exam. The duration of catheterization prior to DVT detection was 3.8 days (range 2-11). All patients with catheter-associated DVT received standard DVT prophylaxis except one patient with disseminated intravascular coagulation. DVT was not associated with a particular catheter type. Catheter-related infection was noted in one patient. Pressure measurements from the femoral site and SVC were equal in all patients except one patient with elevated intra-abdominal pressure. Conclusions: In a critically ill patient population, the incidence of femoral catheter associated DVT is 33%, not recognizable by physical exam and occurs despite standard prophylaxis. Pressure measurements obtained from the SVC catheters and femoral catheters are equal. Clinical Implications: DVT complicating femoral catheterization should be a consideration when central access is needed and multiple sites are available. Pressure measurements obtained from femoral catheters can be used reliably to assess central venous presures.