Catheter-related upper extremity DVT

26 Mar

QUICK PEARLS:

The majority (70-80%) of thrombotic events in the upper extremity deep veins (subclavian, axillary, brachial) occur in the presence of IV catheters.

 

Any catheter has the potential to cause thrombosis. Think about PIV, PICC, tunneled and non-tunneled central catheters, ports and pacemakers.

 

In addition to the classic risk factors that you commonly consider for DVT (prior surgery, malignancy, h/o DVT, etc.), specifically catheter-associated thrombosis is more likely with:

large-diameter catheters (more likely to have stagnate blood v. free flowing)

PICC as compared to centrally placed catheters

-catheter malposition (In one study, DVT developed in 46% of patients whose catheter tip was in the innominate vein or junction of the immoninate vein with the SVC, compared with 6% of patients with a properly positioned catheter)

-chemical irritation (potassium chloride, antibiotics such as vancomycin, diazepam, hypotonic and hypertonic electrolyte solutions)

 

Clinical presentation: inability to withdraw blood, phlebitis, extremity edema

 

Diagnosis is made with Doppler ultrasound.

 

Treatment involves observation, anticoagulation to prevent embolization, and removal of the catheter. Prophylactic systemic anticoagulation is not routinely recommended in this population.

 

Submitted by K Estes.

 

References:  Luciani, et. Al. Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology. 2001;220(3):655. PMID 11526263

Uptodate.com; picture

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