Macro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy study
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 th...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02380-x |
| _version_ | 1797362956769427456 |
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| author | Mika M. Rockholt Leila Naddi Ahmed M. Badri Elisabet Englund Thomas Kander |
| author_facet | Mika M. Rockholt Leila Naddi Ahmed M. Badri Elisabet Englund Thomas Kander |
| author_sort | Mika M. Rockholt |
| collection | DOAJ |
| description | 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 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. |
| first_indexed | 2024-03-08T16:14:52Z |
| format | Article |
| id | doaj.art-f9750486d3a940478175b14167c528f9 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-08T16:14:52Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-f9750486d3a940478175b14167c528f92024-01-07T12:41:45ZengBMCBMC Anesthesiology1471-22532024-01-012411810.1186/s12871-023-02380-xMacro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy studyMika M. Rockholt0Leila Naddi1Ahmed M. Badri2Elisabet Englund3Thomas Kander4Department of Intensive and Perioperative Care, Skåne University HospitalDepartment of Intensive and Perioperative Care, Skåne University HospitalDepartment of Intensive and Perioperative Care, Skåne University HospitalDepartment of Clinical Sciences, Lund UniversityDepartment of Intensive and Perioperative Care, Skåne University HospitalAbstract 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.https://doi.org/10.1186/s12871-023-02380-xCentral venous catheterizationComplicationsCentral venous catheter thrombosisVascular EndotheliumVascular injury |
| spellingShingle | Mika M. Rockholt Leila Naddi Ahmed M. Badri Elisabet Englund Thomas Kander Macro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy study BMC Anesthesiology Central venous catheterization Complications Central venous catheter thrombosis Vascular Endothelium Vascular injury |
| title | Macro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy study |
| title_full | Macro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy study |
| title_fullStr | Macro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy study |
| title_full_unstemmed | Macro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy study |
| title_short | Macro- and microscopic changes in veins with short-term central venous catheters: an observational autopsy study |
| title_sort | macro and microscopic changes in veins with short term central venous catheters an observational autopsy study |
| topic | Central venous catheterization Complications Central venous catheter thrombosis Vascular Endothelium Vascular injury |
| url | https://doi.org/10.1186/s12871-023-02380-x |
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