Yoğun bakım SARS-CoV-2 hastalarında santral venöz katetere bağlı tromboz insidansı ve risk faktörleri

Abstract

Introduction SARS-CoV-2 can cause an increase in both arterial and venous thrombotic events. It is thought that thrombotic events increase in patients due to deep hypoxia, which is the most serious symptom of patients, and the associated immobility. Material- Method 233 patients who were followed up in the 3rd Level Covid Intensive Care Unit of the hospital between 2021-2022 were retrospectively analyzed. It was determined that central venous catheter was applied to 110 patients. The age, gender, BMI, co-morbidities of the patients, and which central venous route is preferred for the catheter will be determined. In addition, the number of punctures, thrombocyte count as well as the use of anticoagulants and acetylsalicylic acid, whether or not he/she received total parenteral nutrition (TPN), and how many days the catheter was left will be recorded and thrombotic events will be determined. Discussion Covid-19 causes vascular pathologies as well as respiratory symptoms. Central venous catheter application is frequent in intensive care due to both treatment and nutritional support, and venous path preference affects the risk of thrombosis. Performing more than one catheter application from the same area, catheter duration and position of the end part of the catheter are important factors for the development of thrombosis. It has been found that thrombotic events related to femoral catheter have increased in SARS-CoV-2 patients hospitalized in intensive care. In our study, although the duration of femoral catheter use was low, the thrombosis rate was found to be high, which supports the literature.This situation has led us to reduce femoral catheter applications in intensive care SARS-CoV-2 patients hospitalized in our clinic and to prefer other catheterization methods. Conclusion In this study, the incidence of thrombosis was found to be higher in patients treated in the intensive care unit due to SARS-CoV-2 infection and who underwent femoral central catheterization compared to the literature. Keywords:Covid-19, Femoral Vein, SARS-COV-2, Thrombosis, Intensive Care

Keywords

• Covid-19
• Femoral Vein
• SARS-COV-2
• Thrombosis
• Intensive Care
• COVID -19
• femoral vein
• intensive care
• SARS-COV-2
• thrombosis

The incidence and risk factors of thrombosis due to central venous catheter in SARS-CoV-2 patients in intensive care

Abstract

Aim: SARS-CoV-2 can cause an increase in both arterial and venous thrombotic events. It is thought that thrombotic events increase in patients due to deep hypoxia, which is the most serious symptom of patients, and the associated immobility.
Material and Method: 233 patients who were followed up in the 3rd Level COVID Intensive Care Unit of the hospital between 2021-2022 were retrospectively analyzed. It was determined that central venous catheter was applied to 110 patients. The age, gender, BMI, co-morbidities of the patients, and which central venous route is preferred for the catheter will be determined. In addition, the number of punctures, thrombocyte count as well as the use of anticoagulants and acetylsalicylic acid, whether or not he/she received total parenteral nutrition (TPN), and how many days the catheter was left will be recorded and thrombotic events will be determined.
Results: COVID-19 causes vascular pathologies as well as respiratory symptoms. Central venous catheter application is frequent in intensive care due to both treatment and nutritional support, and venous path preference affects the risk of thrombosis. Performing more than one catheter application from the same area, catheter duration and position of the end part of the catheter are important factors for the development of thrombosis. It has been found that thrombotic events related to femoral catheter have increased in SARS-CoV-2 patients hospitalized in intensive care. In our study, although the duration of femoral catheter use was low, the thrombosis rate was found to be high, which supports the literature. This situation has led us to reduce femoral catheter applications in intensive care SARS-CoV-2 patients hospitalized in our clinic and to prefer other catheterization methods.
Conclusion: In this study, the incidence of thrombosis was found to be higher in patients treated in the intensive care unit due to SARS-CoV-2 infection and who underwent femoral central catheterization compared to the literature.

Keywords

• COVID -19
• femoral vein
• intensive care
• SARS-COV-2
• thrombosis

References

1. Berlin DA, Gulick RM, Martinez FJ. Ciężki COVID-19. N Engl J Med 2020; 383: 2451-60.
2. Kashi M, Jacquin A, Dakhil B, et al. Severe arterial thrombosis associated with COVID COVID-19 infection. Trombosis Research 2020; 192: 75-7.
3. Henry BM, Vikse J, Benoit S, Favaloro EJ, Lippi G. Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: a novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis. Clinica chimica acta 2020; 507: 167-73.
4. Spiezia L, Boscolo A, Poletto F, et al. COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost 2020; 120: 998-1000.
5. Forauer AR, Theoharis CG, Dasika NL. Jugular vein catheter placement: histologic features and development of catheter-related (fibrin) sheaths in a swine model. Radiology 2006; 240: 427-34.
6. Liangos O, Gul A, Madias NE, Jaber BL. Long-term management of the tunneled venous catheter. Semin Dial 2006; 19: 158-64.
7. Tayebi P. Jugular vein catheterization in critically ill patients with corona virus disease 2019 can increase the surgeon’s exposure. Vasc Specialist Int. 2020; 36: 201–2.
8. Scoppettuolo G, Biasucci DG, Pittiruti M. Vascular access in COVID-19 patients: Smart decisions for maximal safety. The Journal of Vascular Access. 2020; 21: 408-10.

9. Geerts W. Central venous catheter-related thrombosis. Hematology Am Soc Hematol Educ Program. 2014; 1: 306-11.
10. Monreal M, Raventos A, Lerma R, et. al. Pulmonary embolism in patients with upper extremity DVT associated to venous central lines—a prospective study. Thromb Haemost 1994; 72: 548-550.
11. Chopra V, Anand S, Hickner A, et. al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 2013; 382: 311-25.
12. Grant JD, Stevens SM, Woller SC, et. al. Diagnosis and management of upper extremity deep-vein thrombosis in adults. Thromb. Haemost 2012; 108: 1097-108.
13. Akoğlu H, Yılmaz R, Peynircioğlu B, et al. A rare complication of hemodialysis catheters: Superior vena cava syndrome. Hemodialysis Inter 2007;1 1: 385-91.
14. Gray BH, Olin JW, Graor RA, Young JR, Brtholomew JR, Ruschhaupt WF. Safety and efficacy of thrombolytic therapy for superior vena cava syndrome. Chest 1991; 99: 54-9.
15. Romano L, Bilotta F, Dauri M, et al. Short Report- Medical nutrition therapy for critically ill patients with COVID -19. Eur Rev Med Pharmacol Sci. 2020; 24: 4035-9
16. Rooden CJ, Tesselaar ME, Osanto S, Rosendaal FR, Huisman MV. Deep vein thrombosis associated with central venous catheters- a review. J Thromb Haemost. 2005; 3: 2409-19.
17. Kreuziger LB, Jaffray J, Carrier M. Epidemiology, diagnosis, prevention and treatment of catheter-related thrombosis in children and adults. Thromb Research 2017; 157: 64-71.
18. Frank D.A., Meuse J., Hirsch D., Ibrahim J.G., Van den Abbeele A.D.: The treatment and outcome of cancer patients with thromboses on central venous catheters. J. Thromb. Thrombolysis 2000; 10: 271-5.
19. Farge D, Bounameaux H, Brenner B, et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 2016; 17: e452-e466.
20. Yosunkaya A, Çelik JB, Dayıoğlu M, Erkoçak R, Paksoy Y. Santral ven kateterizasyonuna bağlı tromboz ve superior vena kava sendromu. Türk Anest Rean Der Derg 2009; 37: 108-13.