Venous thrombosis, catheter-related

Catheter-related venous thrombosis occurs in 30%-70% of patients with long-term central venous catheters. Fortunately, the majority of patients are asymptomatic (Haire et al. 1991 Wechsler et al. 1993). Complete thrombosis of the parent vein will present as arm, neck, or face swelling. If the thrombus is isolated in the axillary or subclavian vein, ipsilateral arm swelling will occur. If the thrombus propagates... 

In patients who have had a catheter-related venous thrombosis, warfarin therapy (INR 2) is recommended for the duration of the catheter. Low-dose warfarin (1 mg/day) is now often used prophylacti-cally in the cancer population (Bern et al. (1990). 

Mechanical complications of PN are related to catheter placement and the system and equipment used to administer PN. A central venous catheter must be placed by a trained professional, and risks associated with placement include pneumothorax, arterial puncture, bleeding, hematoma formation, venous thrombosis, and air embolism.1,20 Over time, the catheter may require replacement. Problems with the equipment include malfunctions of the infusion pump, intravenous tubing sets, and filters. 

Morbidity and mortality in HIT are related to thrombotic events. Venous thrombosis occurs most commonly, but occlusion of peripheral or central arteries is not infrequent. If an indwelling catheter is present, the risk of thrombosis is increased in that extremity. Skin necrosis has been described, particularly in individuals treated with warfarin in the absence of a direct thrombin inhibitor, presumably due to acute depletion of the vitamin -dependent anticoagulant protein C occurring in the presence of high levels of procoagulant proteins and an active hypercoagulable state. 

Magagnoli, M., Masci, G., Castagna, L., Pedicini, V., Poretti, D., Morenghi, E., Bramhilla, G., Santoro, A. (2006). Prophylaxis of central venous catheter-related thrombosis with minidose warfarin in patients treated with high-dose chemotherapy and peripheral-hlood stemcell transplantation retrospective analysis of 228 cancer patients. Am. J. Hematol. 81(1) 1-4. 

Central venous catheters are reluctantly used as blood access for hemodialysis because of safety concerns and frequent complications, for example sepsis, thrombosis, and vessel stenosis. Nevertheless, 20% or more of all patients rely on atrial catheters for chronic dialysis because of lack of other access. Potentially fatal risks related to central venous catheters include air embolism (1), severe blood loss (2), and electric shock (3). These specific risks have been substantially eliminated by the inherent design and implantation of Dialock (Biolink Corporation, USA). Dialock is a subcutaneous device consisting of a titanium housing with two passages with integrated valves connected to two silicone catheters. The system is implanted subcutaneously below the clavicle. The tips of the catheters are placed in the right atrium. The port is accessed percutaneously with needle cannulas. 

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