Bedside Insertion of Vena Cava Filters in the Intensive Care Unit



The development of deep venous thrombosis (DVT) and pulmonary embolism (PE) remains a daily concern for physicians who care for critically ill patients. Diagnosing PE is challenging in the intensive care unit (ICU) because signs and symptoms are nonspecific. In greater than two-thirds of patients, acute PE occurs prior to the diagnosis of DVT. Subsequently, much emphasis on this disease process focuses on prophylaxis and prevention rather than treatment. Mechanical prophylaxis with graded compression stockings and pharmacologic anticoagulation with heparin, low molecular weight heparin, and warfarin remain the mainstays of prevention and treatment. However, there are patient populations that are at high risk for venous thromboembolism (VTE) who are candidates for the placement of vena cava filters (VCFs).1


Inferior Vena Cava Deep Venous Thrombosis Sterile Drape Mechanical Prophylaxis Filter Insertion 


  1. 1.
    Marino PL. Venous thromboembolism. In: Marino PL, ed. The ICU Book. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1998:106–120.Google Scholar
  2. 2.
    Ehrenwerth J, Sorbo S, Hackel A. Transport of critically ill adults. Crit Care Med. 1986;14:543–547.PubMedCrossRefGoogle Scholar
  3. 3.
    Insel J, Weissman C, Kemper M, Askanazi J, Hyman AI. Cardiovascular changes during transport of critically ill and postoperative patients. Crit Care Med. 1986;14:539–542.PubMedCrossRefGoogle Scholar
  4. 4.
    Taylor JO, Chulay JD, Landers CF, Hood W Jr, Abelman WH. Monitoring high-risk cardiac patients during transportation in the hospital. Lancet. 1970;2:1205–1208.PubMedCrossRefGoogle Scholar
  5. 5.
    Waddell G. Movement of critically ill patients within the hospital. Br Med J. 1975;2:417–419.PubMedCrossRefGoogle Scholar
  6. 6.
    Braman SS, Dunn SM, Amico CA, Millman RP. Complications of intrahospital transport in critically ill patients. Ann Intern Med. 1987;107:469–473.PubMedGoogle Scholar
  7. 7.
    Venkataraman ST, Orr RA. Intrahospital transport of critically ill patients. Crit Care Clin. 1992;8:525–531.PubMedGoogle Scholar
  8. 8.
    Van Natta TL, Morris JA, Eddy VA, et al. Elective bedside surgery in critically injured patients is safe and cost effective. Ann Surg. 1997;227:618–626.CrossRefGoogle Scholar
  9. 9.
    Andrews PJD, Piper IR, Dearden NM, Miller JD. Secondary insults during intrahospital transport of head-injured patients. Lancet. 1990;335:327–330.PubMedCrossRefGoogle Scholar
  10. 10.
    Sing RF, Cicci CK, Smith CH, Messick WJ. Bedside insertion of inferior vena cava filters in the intensive care unit. J Trauma. 1999;47:1104–1107.PubMedCrossRefGoogle Scholar
  11. 11.
    Mostafa G, McKeown R, Huynh TT, Heniford BT. The hazard of scattered radiation in a trauma intensive care unit. Crit Care Med. 2002;30:574–576.PubMedCrossRefGoogle Scholar
  12. 12.
    Kazmers A, Groehn H, Meeker C. Duplex examination of the inferior vena cava. Am Surg. 2000;10:986–989.Google Scholar
  13. 13.
    Benjamin ME, Sandager GP, Cohn EJ, et al. Duplex ultrasound of inferior vena cava filters in multitrauma patients. Am J Surg. 1999;178:92–97.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosenthal D, Wellons ED, Levitt AB, et al. Rose of prophylactic temporary inferior vena cava filters placed at bedside under intravascular ultrasound guidance in patients with multiple trauma. J Vasc Surg. 2000;40:958–964.CrossRefGoogle Scholar
  15. 15.
    Nunn CR, Neuzil D, Naslund T, et al. Cost-effective method for bedside insertion of vena cava filters in trauma patients. J Trauma. 1997;43:752–758.PubMedCrossRefGoogle Scholar
  16. 16.
    Neuzil DF, Garrard CL, Berkman RA, Pierce R, Naslund TC. Duplex-directed vena cava filter placement: report of initial experience. Surgery. 1998;123:470–474.PubMedCrossRefGoogle Scholar
  17. 17.
    Sato DT, Robinson KD, Gregory RT, et al. Duplex directed caval filter insertion in multi-trauma and critically ill patients. Ann Vasc Surg. 1999;13:365–371.PubMedCrossRefGoogle Scholar
  18. 18.
    Matsumura JS, Morasch MD. Filter placement by ultrasound technique at the bedside. Seminars in Vasc Surg. 2000;13:199–203.Google Scholar
  19. 19.
    Schmelzer TM, Christmas AB, Jacobs DG, Heniford BT, Sing RF. Imaging of the vena cava in the intensive care unit prior to vena cava filter insertion: carbon dioxide as an alternative to iodinated contrast. Am Surg. 2008;74:141–145.PubMedGoogle Scholar
  20. 20.
    Sullivan KL, Bonn J, Shapiro MJ, Gardiner GA. Venography with carbon dioxide as a contrast agent. Cardiovasc Intervent Radiol. 1995;18:141–145.PubMedCrossRefGoogle Scholar
  21. 21.
    Sing RF, Stackhouse DJ, Cicci CK, LeQuire MH. Bedside Carbon Dioxide (CO2) preinsertion cavogram for inferior vena cava filter placement: case report. J Trauma. 1999;47:1140–1141.PubMedCrossRefGoogle Scholar
  22. 22.
    Sing RF, Jacobs DG, Heniford BT. Bedside insertion of inferior vena cava filters in the intensive care unit. J Am Col Surg. 2001;192:570–576.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of General SurgeryCarolinas HealthCare SystemCharlotteUSA

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