Venous complications

Jensen S, Huttel MS, Schou Olesen A. Venous complications after i.v. administration of Diazemuls (diazepam) and Dormicum (midazolam) Br J Anaesth 1981 53(10) 1083-5. 

Of 4379 dental patients who received methohexital, 6.7% experienced restlessness, 5.5% respiratory disorders (respiratory obstruction, hiccuping, laryngeal spasm, apnea, or sneezing), 1.1% venous complications, 1.0%... 

Numerous reports of thrombotic venous complications following a PM/ICD system implantation, such as stenosis, occlusion, and SVC syndrome (SVCS), have been published, and their number is increasing. All these manifestations share the same pathogenetic root thrombus formation, as described above, is the initial step of these processes, but it is still not well known why in some patients it does not limit itself to creating fibrosis around the lead or which are the risk factors for such venous complications [54-56]. 

Kosarek L, Hart SR, Schultz L, DiGiovanni N. Increase in venous complications associated with etomidate use during a propofol shortage an example of clinically important adverse effects related to dmg substitution. Ochsner J 2011 11(2) 143-6. 

Ms. Jackson, age 56years, is hospitalized with a venous thrombosis. The primary health care provider orders SC heparin. In developing a care plan for Ms. Jiekson, discuss the nursing interventions that would be most important to prevent complications while administering heparin. Provide a rationale for each intervention. 

Pulmonary hypertension develops late in the course of COPD, usually after the development of severe hypoxemia. It is the most common cardiovascular complication of COPD and can result in cor pulmonale, or right-sided heart failure. Hypoxemia plays the primary role in the development of pulmonary hypertension by causing vasoconstriction of the pulmonary arteries and by promoting vessel wall remodeling. Destruction of the pulmonary capillary bed by emphysema further contributes by increasing the pressure required to perfuse the pulmonary vascular bed. Cor pulmonale is associated with venous stasis and thrombosis that may result in pulmonary embolism. Another important systemic effect is the progressive loss of skeletal muscle mass, which contributes to exercise limitations and declining health status. 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

Both vasoconstrictors and vasodilators have been used in the treatment of priapism. Vasoconstrictors are thought to work by forcing blood out of the cavernosum and into the venous return. Aspiration of the penile blood followed by intracavenous irrigation with epinephrine (1 1,000,000 solution) has been effective with minimal complications.37 In severe cases, surgical intervention to place penile shunts has been used, but there is a high failure rate, and the risk of complications, from skin sloughing to fistulas, limits its use. 

Because of the need for repeated venous access, a central venous catheter or infusion port is placed prior to starting treatment. These devices are useful not only for delivery of chemotherapy but also to support patients during periods of myelosuppression. Infection and bleeding complications are the primary cause of mortality in patients with leukemia. 

The role of diuretics in the management of SVCS is controversial. While patients may derive symptomatic relief from edema, complications such as dehydration and reduced venous blood flow may exacerbate the condition. If diuretics are used, furosemide is used most frequently with diligent monitoring of the patient s fluid status and blood pressure. 

PPN admixtures should be coinfused with intravenous lipid emulsion when using the 2-and-l PN because this may decrease the risk of phlebitis. Infectious and mechanical complications may be lower with PPN compared with central venous PN administration. However, because of the risk of phlebitis and osmolarity limit, PPN admixtures have low macronutrient concentrations and therefore require large fluid volumes to meet a patient s nutritional requirements. Given these limitations, every effort should be made to obtain central venous... 

Central PN refers to the administration of PN via a large central vein, and the catheter tip must be positioned in the vena cava. Central PN allows the infusion of a highly concentrated, hypertonic nutrient admixture. The typical osmolarity of a central PN admixture is about 1500 to 2000 mOsm/L. Central veins have much higher blood flow, and the PN admixture is diluted rapidly on infusion, so phlebitis is usually not a concern. Patients who require PN administration for longer periods of time (greater than 7 days) should receive central PN. One limitation of central PN is the need for placement of a central venous catheter and an x-ray to confirm placement of the catheter tip. Central venous catheter placement may be associated with complications, including pneumothorax, arterial injury, air embolus, venous thrombosis, infection, chylothorax, and brachial plexus injury.1,20... 

Patients receiving central PN are at increased risk of developing infectious complications caused by bacterial and fungal pathogens.1,50 Infections maybe related to placement of a central venous catheter, contamination of a central venous catheter or... 

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. 

Whereas (32 glycoprotein 1 ((J2-GPI) is the target of anticardiolipin antibodies, prothrombin is the antigen for most lupus anticoagulants. Both these antibodies are risk factors for both venous and arterial thrombosis. In addition, complications such as thrombocytopenia and recurrent miscarriages are manifestations of the so-called antiphospholipid syndrome (97). 

A complete or global tissue distribution model consists of individual tissue compartments connected by the blood circulation. In any global model, individual tissues may be blood flow-limited, membrane-limited, or more complicated structures. The venous and arterial blood circulations can be connected in a number of ways depending on whether separate venous and arterial blood compartments are used or whether right and left heart compartments are separated. The two most common methods are illustrated in Figure 3 for blood flow-limited tissue compartments. The associated mass balance equations for Figure 3A are... 

Complications of MI include cardiogenic shock, heart failure, valvular dysfunction, various arrhythmias, pericarditis, stroke secondary to left ventricular (LV) thrombus embolization, venous thromboembolism, and LV free-wall rupture. 

Patients with acute stroke should be monitored intensely for the development of neurologic worsening, complications, and adverse effects from treatments. The most common reasons for clinical deterioration in stroke patients are (1) extension of the original lesion in the brain (2) development of cerebral edema and raised intracranial pressure (3) hypertensive emergency (4) infection (e.g., urinary and respiratory tract) (5) venous thromboembolism (6) electrolyte abnormalities and rhythm disturbances and (7) recurrent stroke. The approach to monitoring stroke patients is summarized in Table 13-3. 

Postthrombotic syndrome (a long-term complication of DVT caused by damage to venous valves) may produce chronic lower extremity swelling, pain, tenderness, skin discoloration, and ulceration. 

The Italian study subanalysis identifies as independent predictors of VTE age > 60 years, height > 165 cm, and diastolic blood pressure > 90 mm. Also relevant is the association between high global cardiovascular risk scores and VTE incidence. This means that there is a correlation between arterial and venous risks, and consequently prevention of arterial complications will also mean lower venous risk (Decensi et al. 2005 Goldhaber 2005) (Fig. 10.9). 

Cancer is a complicated process consisting of well-coordinated multiple steps. Randomized trials to study the effectiveness of LMW heparins as compared with unfractionated heparin in treating venous thromboembolism in cancer patients led to a surprising observation that treatment with heparin... 

Monreal M, Davant E. Thrombotic complications of central venous catheters in cancer patients. Acta Haematol 2001 106(l-2) 69-72. 

Accessory measures insertion of a peritoneo-venous shunt to allow transfer of ascitic fluid to the venous compartment has largely been abandoned due to frequent shunt obstruction, peritoneal infection and the occurrence of encephalopathy. TIPS is as effective in relieving ascites as paracentesis with albumin replacement, but shunts can quickly become obstructed, and hepatic encephalopathy is a common complication. 

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