Coagulation Changes in Trauma Patients

We will enroll all patients who will be getting a Central Venous Catheter (CVC) placed
either in the PICC Insertion Room or in a surgical intensive care unit who are undergoing
emergent central venous catheter placement for a medically indicated reason. All patients
who have not had a previous central line or will be getting their catheter exchanged over
guide wire are eligible.

At Baseline:

We intend to evaluate the patient for a Deep Vein Thrombosis by conducting a duplex
ultrasound of the lower extremities prior to line insertion. We will also collect one sample
of blood at baseline within 3 hours of insertion.

During CVC Insertion:

One sample of blood will be collected during CVC insertion.

Follow Up:

The last blood sample will be collected soon after CVC insertion (approximately 3hrs). Blood
samples will only be drawn when we are available to collect them. Thus, this is defined as a
"sample of convenience". We will also conduct another duplex ultrasound of the extremities
after CVC insertion for evaluation of DVT.

Data will be collected on the duplex ultrasound result, the type of central line and the
exact insertion site. Should a DVT be found, the attending physician will be made aware
according to clinical protocol.

Normally, at the moment of central venous puncture, 5cc of blood is aspirated and wasted to
confirm correct placement of the needle tip before placement of the guidewire. For the
intended study, instead of wasting that blood, we will save 500 microliters of it for
coagulation analysis. Immediately after the catheter is inserted over the guidewire, a chest
x-ray is obtained to verify position of the catheter. At this point, each port of the
central venous catheter is aspirated and wasted before infusion through the central venous
catheter. For the purpose of this study, we will save 500 microliters of that wasted blood
for coagulation analysis. To clarify, the second 500 microliters will be drawn through the
newly placed central venous catheter ports and saved (instead of being drawn and wasted).
Drawing back on each port before infusing is standard practice. This second sample will
contain a small amount of saline, but, based on a few trials in the animal lab, this saline
is unlikely to effect the coagulation analysis.

In summary, we intend to visit the patient 3 times over approximately a 4 hour period for
the purpose of collecting blood that would normally otherwise be wasted (a total of 1500
microliters). This will be done only on patients who are undergoing the procedure for for a
medically indicated reason and medical care will not be changed, affected, or otherwise
altered based on involvement in this study. Our purpose is simply to collect 3 samples of
blood during emergent central venous catheter placement that would otherwise be wasted into
the biohazard container.

We will use this blood to assay prothrombin time, partial thromboplastin time,
thromboelastography, Prothrombin Fragment 1.2, Factor VIII, and VonWillebrand's Factor.

Inclusion Criteria:

- All patients undergoing placement of a central venous catheter.

Exclusion Criteria:

- Age under 18 or known coagulation disorder (inherited or pharmacologic).