Abstract
Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications.
Source: We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE.
Principle findings: The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial.
Conclusion: Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.
Résumé
Objectif: Les cathéters veineux centraux (CVC) sont couramment utilisés dans les soins aux malades en phase critique. Bien que la thrombose soit une complication fréquente et bien reconnue associée à leur utilisation, les complications thromboemboliques associées aux CVC, notamment l’embolie pulmonaire et la thromboembolie du coeur droit, surviennent moins fréquemment et échappent au diagnostic. Peu d’informations existent pour guider le clinicien dans le diagnostic et la prise en charge des complications thromboemboliques associées à l’utilisation de CVC.
Source: Nous avons revu et résumé de façon critique la littérature soulignant l’incidence de thrombose associée aux CVC. Nous mettons en évidence les risques qui favorisent l’apparition de complications thromboemboliques et proposons des approches permettant le diagnostic et la prise en charge de la thromboembolie du coeur droit.
Constatations principales: L’incidence de thromboses associées aux CVC varie selon des facteurs liés au patient, au site, à l’instrument et à la solution intraveineuse choisie. La thrombose associée aux cathéters veineux centraux constitue une source importante de morbidité et de mortalité chez les patients affectés. L’embolie pulmonaire survient chez environ 15 % des patients souffrant de thrombose veineuse profonde des membres supérieurs associée aux CVC. Un recours plus fréquent à l’échocardiographie transœsophagienne dans la prise en charge des patients présentant une embolie pulmonaire suspectée ou confirmée a permis de détecter plus souvent une thromboembolie du coeur droit. Bien que nous sachions que la survenue de thromboembolie du coeur droit, lorsque associée à une embolie pulmonaire, augmente la mortalité, aucune étude clinique n’a encore déterminé de stratégie optimale pour sa prise en charge.
Conclusion: La thrombose associée à l’utilisation de cathéters veineux centraux survient fréquemment et constitue une source importante de morbidité et de mortalité chez les patients touchés. Notre synthèse appuie le fait qu’il a été démontré que la chirurgie et la thrombolyse améliorent la survie des patients souffrant de thromboembolie du cœur droit et d’embolie pulmonaire. Cependant, des considérations importantes concernant le patient, le caillot et l’institution en cause nécessitent que le traitement des patients souffrant de ces affections soit personnalisé.
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Dr. Burns holds a Clinician Scientist Award from the Canadian Institute of Health Research. Conflicts of interest: The authors have no conflicts of interest to declare.
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Burns, K.E.A., McLaren, A. A critical review of thromboembolic complications associated with central venous catheters. Can J Anesth 55, 532–541 (2008). https://doi.org/10.1007/BF03016674
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DOI: https://doi.org/10.1007/BF03016674