| ||Central Venous Catheter (CVCs) ||Peripherally Inserted Central Catheters (PICCs) |
|Symptomatic DVT ||1–10% ||1–4% |
|Asymptomatic DVT (documented by venography) ||~30% ||~20% |
|Catheter occlusion (without DVT) ||~10% || |
Local vein compression by tumor
Upper extremity DVT predication score8
|Parameter Category ||Point Designation |
|Presence of catheter or access device in a subclavian or jugular vein or a pacemaker ||+1 |
|Unilateral pitting edema in catheterized extremity ||+1 |
|Localized pain in catheterized extremity ||+1 |
|Another diagnosis at least as plausible ||−1 |
|Probability Category (Prevalence) ||Risk Score |
|Low (9–13%) ||−1 or 0 |
|Intermediate (20–38%) ||+1 |
|High (64–70%) ||>1 |
Ultrasound: Use for jugular, axillary, and subclavian veins (sensitivity and specificity 80%)
Venography: Use for more central veins including innominate and vena cava, and when high clinical suspicion despite negative ultrasound
Complications of Upper Limp DVT5
Pulmonary embolism (PE): The incidence of clinical overt PE is estimated at 12%; the incidence of PE in persons with cancer is higher at 15–25%
Postphlebitic syndrome occurs in ~15%
Risk Factors Associated with Central Venous Catheter-Related Thromboembolism Among Patients with Cancer9
Risk Factors Associated with Central Venous Catheter-Related Thromboembolism Among Patients with Cancer
Thrombogenicity of catheter material (polyethylene > polyurethane or silicone)
Large catheter diameter and number of lumens
Malpositioned catheter tip
Percutaneous insertion > cut down
More than 1 insertion attempt
Prior CVC insertion
Subclavian vein insertion > internal jugular insertion
|Patient and Vascular |
Fibrinous catheter lumen occlusion
Extrinsic vascular compression (enlarged cervical and/or mediastinal lymph nodes, etc)
Factor V Leiden mutation (and perhaps other thrombophilias)
Prior venous thromboembolism
Estrogens and/or progesterone
Growth factors (ie, epoetin, GM-CSFs, G-CSFs)
Heparin-induced thrombocytopenia and thrombosis (HIT, HITT)
Treatment of Catheter-Related Venous Thrombosis10,11,12,13
Treatment of Catheter-Related Venous Thrombosis
If a CVC is functioning and does not appear to be infected, there is no imperative to remove it
If CVC removal is planned, consider full anticoagulation with unfractionated or low-molecular-weight heparin for 5–7 days prior to removal to reduce the risk embolization with device extraction
Clinicians should keep in mind patients with active malignancy may require prolonged anticoagulation after catheter removal should it be determined that the event occurred independent of the presence of CVC (eg, an additional thrombotic event distant to catheter site)
Catheter-related thrombosis occurring in patients with HIT/HITT is a special circumstance. These patients should receive a direct thrombin inhibitor or fondaparinux for acute anticoagulation with a transition to warfarin or fondaparinux for ...
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