Macro- and microscopic changes in veins with short-term central venous catheters : an observational autopsy study
Rockholt, Mika M LU
; Naddi, Leila
LU
; Badri, Ahmed M
; Englund, Elisabet
LU
and Kander, Thomas
LU
(2024)
In BMC Anesthesiology
24(1).
- Abstract
BACKGROUND: Centrally inserted central catheters (CICCs) are indispensable in modern healthcare, but unfortunately, come with complications. Catheter-related thrombosis is a well-known complication reported to occur in 5-30% of patients with CICC. There is a paucity of studies that report the incidence of catheter-related thrombosis after the introduction of real-time ultrasound insertion guidance as clinical practice. This study aimed to demonstrate any pathological macro- or microscopic changes in the vein wall associated with CICCs.
METHODS: The study was approved by the Swedish Ethical Review Authority and was conducted at a large university hospital. The study included 12 patients with a short-term CICC who were subject to... (More)
BACKGROUND: Centrally inserted central catheters (CICCs) are indispensable in modern healthcare, but unfortunately, come with complications. Catheter-related thrombosis is a well-known complication reported to occur in 5-30% of patients with CICC. There is a paucity of studies that report the incidence of catheter-related thrombosis after the introduction of real-time ultrasound insertion guidance as clinical practice. This study aimed to demonstrate any pathological macro- or microscopic changes in the vein wall associated with CICCs.
METHODS: The study was approved by the Swedish Ethical Review Authority and was conducted at a large university hospital. The study included 12 patients with a short-term CICC who were subject to autopsies. Vessels with inserted catheters were macroscopically and microscopically examined.
RESULTS: In total, seven female and five male patients with a median age of 70 (interquartile range 63-76) were included. With one exception, all patients received routine thromboprophylaxis throughout the period with CICC. Most inserted CICCs were 9.5 French (54%) and were inserted in the internal jugular vein (92%). The median time with CICC was seven days (interquartile range 1.8-20). At autopsy, thrombi were observed in all cases (100%), macroscopically and microscopically, attached to the distal portion of the CICC and/or the adjacent vessel wall. Inflammatory changes in the vessel walls were seen in all cases, and varying degrees of fibrosis were demonstrated in eight cases (67%).
CONCLUSIONS: This autopsy study demonstrated that catheter-related thrombus formation with adjacent inflammatory and fibrotic vessel wall thickening was very common, despite a limited period of catheter use. The consequences of these findings are important, as thrombi may cause pulmonary embolism and possibly lead to catheter-related infections, and since inflammatory and fibrotic vessel wall thickening may evolve into chronic venous stenosis. Furthermore, the findings are a cause of concern, as CICCs are indispensable in modern healthcare and complications may be masked by the general disease that was the indication for CICC insertion.
(Less)
- author
- Rockholt, Mika M
LU
; Naddi, Leila
LU
; Badri, Ahmed M
; Englund, Elisabet
LU
and Kander, Thomas
LU
- organization
- publishing date
- 2024-01-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Humans, Male, Female, Central Venous Catheters/adverse effects, Catheterization, Central Venous/adverse effects, Anticoagulants, Venous Thromboembolism, Thrombosis/epidemiology, Jugular Veins, Autopsy, Catheters, Indwelling, Catheterization, Peripheral
- in
- BMC Anesthesiology
- volume
- 24
- issue
- 1
- article number
- 5
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85181221665
- pmid:38166620
- ISSN
- 1471-2253
- DOI
- 10.1186/s12871-023-02380-x
- language
- English
- LU publication?
- yes
- id
- 59f1e403-dd89-4680-8c03-b8907726a3b7
- date added to LUP
- 2024-01-07 18:20:09
- date last changed
- 2024-04-23 00:52:33
@article{59f1e403-dd89-4680-8c03-b8907726a3b7,
abstract = {{<p>BACKGROUND: Centrally inserted central catheters (CICCs) are indispensable in modern healthcare, but unfortunately, come with complications. Catheter-related thrombosis is a well-known complication reported to occur in 5-30% of patients with CICC. There is a paucity of studies that report the incidence of catheter-related thrombosis after the introduction of real-time ultrasound insertion guidance as clinical practice. This study aimed to demonstrate any pathological macro- or microscopic changes in the vein wall associated with CICCs.</p><p>METHODS: The study was approved by the Swedish Ethical Review Authority and was conducted at a large university hospital. The study included 12 patients with a short-term CICC who were subject to autopsies. Vessels with inserted catheters were macroscopically and microscopically examined.</p><p>RESULTS: In total, seven female and five male patients with a median age of 70 (interquartile range 63-76) were included. With one exception, all patients received routine thromboprophylaxis throughout the period with CICC. Most inserted CICCs were 9.5 French (54%) and were inserted in the internal jugular vein (92%). The median time with CICC was seven days (interquartile range 1.8-20). At autopsy, thrombi were observed in all cases (100%), macroscopically and microscopically, attached to the distal portion of the CICC and/or the adjacent vessel wall. Inflammatory changes in the vessel walls were seen in all cases, and varying degrees of fibrosis were demonstrated in eight cases (67%).</p><p>CONCLUSIONS: This autopsy study demonstrated that catheter-related thrombus formation with adjacent inflammatory and fibrotic vessel wall thickening was very common, despite a limited period of catheter use. The consequences of these findings are important, as thrombi may cause pulmonary embolism and possibly lead to catheter-related infections, and since inflammatory and fibrotic vessel wall thickening may evolve into chronic venous stenosis. Furthermore, the findings are a cause of concern, as CICCs are indispensable in modern healthcare and complications may be masked by the general disease that was the indication for CICC insertion.</p>}},
author = {{Rockholt, Mika M and Naddi, Leila and Badri, Ahmed M and Englund, Elisabet and Kander, Thomas}},
issn = {{1471-2253}},
keywords = {{Humans; Male; Female; Central Venous Catheters/adverse effects; Catheterization, Central Venous/adverse effects; Anticoagulants; Venous Thromboembolism; Thrombosis/epidemiology; Jugular Veins; Autopsy; Catheters, Indwelling; Catheterization, Peripheral}},
language = {{eng}},
month = {{01}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Anesthesiology}},
title = {{Macro- and microscopic changes in veins with short-term central venous catheters : an observational autopsy study}},
url = {{http://dx.doi.org/10.1186/s12871-023-02380-x}},
doi = {{10.1186/s12871-023-02380-x}},
volume = {{24}},
year = {{2024}},
}