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Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study

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Abstract

Purpose

Central venous catheter (CVC)-related thrombosis (CRT) is a known complication in critically ill patients. However, its clinical significance remains unclear. The objective of the study was to evaluate the occurrence and evolution of CRT from CVC insertion to removal.

Methods

A prospective multicenter study was conducted in 28 intensive care units (ICUs). Duplex ultrasound was performed daily from CVC insertion until at least 3 days after CVC removal or before patient discharge from the ICU to detect CRT and to follow its progression. CRT diameter and length were measured and diameter > 7 mm was considered extensive.

Results

The study included 1262 patients. The incidence of CRT was 16.9% (95% confidence interval 14.8–18.9%). CRT was most commonly found in the internal jugular vein. The median time from CVC insertion to CRT onset was 4 (2–7) days, and 12% of CRTs occurred on the first day and 82% within 7 days of CVC insertion. CRT diameters > 5 mm and > 7 mm were found in 48% and 30% of thromboses. Over a 7-day follow-up, CRT diameter remained stable when the CVC was in place, whereas it gradually decreased after CVC removal. The ICU length of stay was longer in patients with CRT than in those without CRT, and the mortality was not different.

Conclusion

CRT is a frequent complication. It can occur as soon as the CVC is placed and mostly during the first week following catheterization. Half of the thromboses are small but one-third are extensive. They are often non-progressive and may be resolved after CVC removal.

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Availability of data and material

Deidentified individual participant data are available indefinitely in the electronic database. Data can be accessed with the approval of the authors. Request for data can be made to the corresponding author (qinlu@zju.edu.cn) and will be discussed during a meeting of the study group of Central Venous Catheter-related Thrombosis.

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Acknowledgements

We acknowledge the contribution of Qijiang Chen, Weili Hong, Zhiping huang, Luping Wang, Dengpan Lai, Ning Zhang, Lujiao Mo, Yunchao Shi, Wansheng Li, Qin Chen, Hong Liu, Jie Qin, Chen Zhu, Binbin Wu, Lifeng Wu, Weidong Tang, Qingyu Wang, Weiting Chen, Guojuan Ding, Tao Zhang, Bei Tang, Jian Bo, Laifa Kong, Qunjie Pan, Jinyan Fang, Junzhong Ke, Zhaohui Ji in the development and execution of this study.

Members of the Study Group of Central Venous Catheter-related Thrombosis: Chunshuang Wu, Mao Zhang, Wenjie Gu, Hong Liu, Qin Lu, Second Affiliated Hospital, Zhejiang University School of Medicine. Caimu Wang, Qijiang Chen, The First hospital of Ninghai. Weili Hong, Xudong Zheng, Ruian People’s Hospital. Junfeng Zhang, Zhiping huang, Beilun District People's Hospital. Xingwen Zhang, Luping Wang, Hunan People’s Hospital. Shijin Lv, Dengpan Lai, The Affilated Hospital of Hangzhou Normal University. Xuwei He, Ning Zhang, Qingli Chen, Lishui People’s Hospital. Xiaoyuan Shen, Lujiao Mo, the First People’s Hospital of Xiaoshan District. Wenlong Wei, Yunchao Shi, Jiaxing First Hospital. Guotao Wang, Wansheng Li, Taizhou Municipal Hospital. Yingru Lu, Qin Chen, the First Affiliated Hospital of Wenzhou Medical University. Renfei Shan, Jie Qin, Taizhou Hospital of Zhejiang Province. Lingcong Wang, Chen Zhu, the First Affiliated Hospital of Zhejiang Chinese Medical University. Feng Wu, Binbin Wu, Zhejiang Quhua Hospital. Ting Shen, Lifeng Wu, Yuyao People’s Hospital of Zhejiang Province. Xuebo Shao, Weidong Tang, the First People’s Hospital of Fuyang Hangzhou. Qingyu Wang, Shaoyi Xu, the Second Hospital of Jiaxing. Fuzheng Tao, Weiting Chen, Taizhou Integrated Chinese and Western Medicine Hospital. Haiying Cai, Guojuan Ding, Shaoxing People’s Hospital. Tao Zhang, Qunjie Pan, Lishui Municipal Central Hospital. Bei Tang, the First People’s Hospital of Jiande. Jianbo Gao, Fuyang District Maternity and Child Care Hospital. Laifa Kong, Jinhua Municipal Central Hospital Medical Group. Jinyan Fang, Hangzhou First People’s Hospital. Junzhong Ke, the First People’s Hospital of Wenling. Zhaohui Ji, the First People’s Hospital of Huzhou.

Funding

This work was supported by a grant from the 2015 Welfare Scientific Research Project from the Chinese Ministry of Health (2015SQ00050).

Author information

Author notes

  1. Chunshuang Wu and Mao Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Chunshuang Wu, Mao Zhang, Wenjie Gu & Qin Lu

  2. Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China

    Chunshuang Wu, Mao Zhang, Wenjie Gu & Qin Lu

  3. Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China

    Chunshuang Wu, Mao Zhang, Wenjie Gu & Qin Lu

  4. The First Hospital of Ninghai, Ningbo, China

    Caimu Wang

  5. Ruian People’s Hospital, Wenzhou, China

    Xudong Zheng

  6. Beilun District People’s Hospital, Ningbo, China

    Junfeng Zhang

  7. Hunan People’s Hospital, Changsha, China

    Xingwen Zhang

  8. The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China

    Shijin Lv

  9. Lishui People’s Hospital, Lishui, China

    Xuwei He & Qingli Chen

  10. The First People’s Hospital of Xiaoshan District, Hangzhou, China

    Xiaoyuan Shen

  11. Jiaxing First Hospital, Jiaxing, China

    Wenlong Wei

  12. Taizhou Municipal Hospital, Taizhou, China

    Guotao Wang

  13. The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Yingru Lu

  14. Taizhou Hospital of Zhejiang Province, Taizhou, China

    Renfei Shan

  15. The First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, China

    Lingcong Wang

  16. Zhejiang Quhua Hospital, Quzhou, China

    Feng Wu

  17. Yuyao People’s Hospital of Zhejiang Province, Ningbo, China

    Ting Shen

  18. The First People’s Hospital of Fuyang, Hangzhou, Hangzhou, China

    Xuebo Shao

  19. The Second Hospital of Jiaxing, Jiaxing, China

    Jiming Cai

  20. Taizhou Integrated Chinese and Western Medicine Hospital, Taizhou, China

    Fuzheng Tao

  21. Shaoxing People’s Hospital, Shaoxing, China

    Haiying Cai

Authors
  1. Chunshuang Wu
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  2. Mao Zhang
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Consortia

the Study Group of Central Venous Catheter-related Thrombosis

  • Chunshuang Wu
  • , Mao Zhang
  • , Wenjie Gu
  • , Hong Liu
  • , Qin Lu
  • , Caimu Wang
  • , Qijiang Chen
  • , Weili Hong
  • , Xudong Zheng
  • , Junfeng Zhang
  • , Zhiping Huang
  • , Xingwen Zhang
  • , Luping Wang
  • , Shijin Lv
  • , Dengpan Lai
  • , Xuwei He
  • , Ning Zhang
  • , Qingli Chen
  • , Xiaoyuan Shen
  • , Lujiao Mo
  • , Wenlong Wei
  • , Yunchao Shi
  • , Guotao Wang
  • , Wansheng Li
  • , Yingru Lu
  • , Qin Chen
  • , Renfei Shan
  • , Jie Qin
  • , Lingcong Wang
  • , Chen Zhu
  • , Feng Wu
  • , Binbin Wu
  • , Ting Shen
  • , Lifeng Wu
  • , Xuebo Shao
  • , Weidong Tang
  • , Qingyu Wang
  • , Shaoyi Xu
  • , Fuzheng Tao
  • , Weiting Chen
  • , Haiying Cai
  • , Guojuan Ding
  • , Tao Zhang
  • , Qunjie Pan
  • , Bei Tang
  • , Jianbo Gao
  • , Laifa Kong
  • , Jinyan Fang
  • , Junzhong Ke
  •  & Zhaohui Ji

Contributions

Patient recruitment: CW, CMW, XZ, JZ, SL, XH, XS, WW, GW, YL, QC, RS, LW, FW, TS, XS, JC, FT, HC, TZ, BT, JG, LK, QP, JF, JK, ZJ. Data collection: CW, WG, QL, CMW, XZ, JZ, XZ, SL, XH, XS, WW, GW, YL, QC, RS, LW, FW, TS, XS, JC, FT, HC, TZ, BT, JG, LK, QP, JF, JK, ZJ. Data interpretation and analysis: CW, WG, QL. Drafting of the manuscript: CW, MZ, QL. Study design: CW, MZ. All authors were involved in the editing and approval of the final manuscript.

Corresponding author

Correspondence to Qin Lu.

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The authors declare no conflict of interests.

Ethical approval

The protocol was prospectively approved by Human Research Ethics Committee of the Second Affiliated Hospital of Zhejiang University and the relevant ethics committees in all study sites.

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Consent to participate was provided prospectively from all participants or their next of kin. The authors all consent to publication of the manuscript.

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The members of the Study Group of Central Venous Catheter-related Thrombosis are listed in the acknowledgement section.

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Wu, C., Zhang, M., Gu, W. et al. Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study. Intensive Care Med 49, 401–410 (2023). https://doi.org/10.1007/s00134-023-07006-x

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