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Macro- and microscopic changes in veins with short-term central venous catheters : an observational autopsy study

Rockholt, Mika M LU orcid ; Naddi, Leila LU ; Badri, Ahmed M ; Englund, Elisabet LU orcid and Kander, Thomas LU orcid (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.

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author
; ; ; and
organization
publishing date
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
2024-05-21 03:05:19
@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}},
}