Document Detail

Phlegmasia cerulea dolens with compartment syndrome: a complication of femoral vein catheterization.
MedLine Citation:
PMID:  10834724     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Central venous catheterization is commonly performed in the critically ill. The femoral vein is widely accepted as an insertion site with complications thought to be comparable to other central access sites. We used serial ultrasound examinations with Doppler to examine the evolution of a heretofore undescribed complication of femoral vein catheterization, phlegmasia cerulea dolens with compartment syndrome. DESIGN: Serial ultrasounds were performed in patients before the insertion of femoral venous catheters and sequentially every 48 hrs while the catheters were in place. The noncatheterized leg served as a control. SETTING: A trauma and life support center of a tertiary multidisciplinary critical care unit. PATIENT: A 32-yr-old man with respiratory failure as a consequence of a severe community-acquired pneumonia that required central venous access for antibiotics because no peripheral sites could be obtained. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The initial ultrasound examination of both legs before femoral catheter insertion revealed no sign of venous thrombosis. Ultrasound of the catheterized leg at 48 hrs revealed a small nonocclusive thrombosis, whereas the opposite leg remained normal. At 72 hrs, the catheterized leg had clinical and ultrasonographic evidence of a massive thrombosis. A compartment syndrome defined by pressure measurements soon ensued and required emergent surgical release. CONCLUSIONS: This case report and a review of the available literature suggest that thrombosis associated with femoral vein catheterization should be considered when clinicians decide where to obtain central venous access when multiple sites are available. This report also suggests the utility of serial ultrasound examinations to define clinically nonapparent thrombosis as an early indicator of a potentially catastrophic complication.
K E Wood; J S Reedy; M A Pozniak; D B Coursin
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  28     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-06-08     Completed Date:  2000-06-08     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1626-30     Citation Subset:  AIM; IM    
University of Wisconsin Hospital and Clinics, Trauma and Life Support Center, Madison 53792-2454, USA.
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MeSH Terms
Catheterization, Central Venous*
Ceftriaxone / administration & dosage
Compartment Syndromes / ultrasonography*
Critical Care
Drug Therapy, Combination / therapeutic use*
Erythromycin / administration & dosage
Femoral Vein / ultrasonography
Pneumonia, Bacterial / drug therapy*
Respiratory Insufficiency / drug therapy*
Thrombophlebitis / ultrasonography*
Reg. No./Substance:
114-07-8/Erythromycin; 73384-59-5/Ceftriaxone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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