Central Venous Catheter Clots: Incidence, Clinical Significance and Catheter Care in Patients with Hematologic Malignancies

Barzaghi, A; Dell'Orto, Mariagrazia; Rovelli, Attilio; Rizzari, Carmelo; Colombini, Antonella; Uderzo, C

doi:10.3109/08880019509029565

Cited by 46 publications

(43 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The asymptomatic DVT observed in PAARKA were clinically significant-two thirds occluded more than 50% of the vessel and had collateral veins. Short-term complications of CVL-related DVT, symptomatic and asymptomatic, are pulmonary embolism, 32,33 chylothorax, 34 embolic stroke through intracardiac right-to-left shunting, 35 CVL-related sepsis, 36,37 and repeated loss of CVL patency requiring local thrombolytic therapy or CVL replacement. 36 A limitation of the present study is that follow-up lasted only a few weeks; therefore, the long-term outcome of VTE is unknown.…”

Section: Discussionmentioning

confidence: 99%

Central venous line–related thrombosis in children: association with central venous line location and insertion technique

Male

Chait

Andrew

et al. 2003

Blood

220

164

View full text Add to dashboard Cite

Venous thromboembolic events (VTEs) in children are associated with central venous lines (CVLs). The study objective was to assess whether CVL location and insertion technique are associated with the incidence of VTE in children. We hypothesized that VTE would be more frequent with (1) CVL location on the left body side, (2) CVL location in the subclavian vein rather than the jugular vein, and (3) CVL insertion by percutaneous technique rather than venous cut-down. This was a prospective, multicenter cohort study in children with acute lymphoblastic leukemia who had a CVL placed in the upper venous system during induction chemotherapy. Characteristics of CVL were documented prospectively. All children had outcome assessment for VTE by objective radiographic tests, including bilateral venography, ultrasound, echocardiography, and cranial magnetic resonance imaging. Among 85 children, 29 (34%) had VTE; 28 VTEs appeared in the upper venous system, and 1 was sinovenous thrombosis. Left-sided CVL (odds ratio [OR], 2.5; 95% confidence interval, 1.0-6.4; P ‫؍‬ .048), subclavian CVL (OR, 3.1; 95% CI, 1.2-8.5; P ‫؍‬ .025), and percutaneous CVL insertion (OR, 3.5; 95% CI, 1.3-9.2; P ‫؍‬ .011) were associated with an increased incidence of VTE. Interaction occurred between CVL vein location and insertion technique. Subclavian vein CVL inserted percutaneously had an increased incidence (54%) of VTE compared with any other combination (P ‫؍‬ .07). For CVL in the upper venous system, CVL placement on the right side and in the jugular vein may reduce the risk for CVL-related VTE. If subclavian vein placement is necessary, CVL insertion by venous cutdown appears preferable over percutaneous insertion.

show abstract

Section: Discussionmentioning

confidence: 99%

Central venous line–related thrombosis in children: association with central venous line location and insertion technique

Male

Chait

Andrew

et al. 2003

Blood

220

164

View full text Add to dashboard Cite

show abstract

“…In an autopsy study of patients with CVCs, 7 of 31 (23%) patients with CVCs with clots and 0 of 41 (0%) patients with CVCs without clots documented at autopsy had previously experienced an associated bacteremia [17,18]. In a separate study, 5 of 28 (18%) patients with CVCs with clots had clinical infections versus 0 of 10 (0%) patients with CVCs without clots [40]. The odds ratio for infection related to thrombosis was 4.1 (confidence interval 1.5-11.4) [32], and prophylactic heparin/vancomycin/ciprofloxacin or heparin/vancomycin flushes resulted in a threefold lower incidence of blood infection compared with heparin alone [52].…”

Section: Infection Of Cvcsmentioning

confidence: 97%

“…In addition, there is a lack of uniform standards in reporting this sort of information. In a smaller group of studies, all patients underwent venographic studies at some time after their CVC placements irrespective of symptoms [14,15,17,35,[40][41][42][43][44][45][46][47][48]. These venographic studies (Table 4) showed that approximately 41% (range 12%-74%) of all patients with CVCs developed thrombi.…”

Section: Cvc-related Blood Vessel Thrombosis (Dvt)mentioning

confidence: 99%

Thrombotic Complications of Central Venous Catheters in Cancer Patients

2004

View full text Add to dashboard Cite

Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Aside from the complications (pneumothorax, hemorrhage) associated with their initial insertion, all of these CVCs are associated with the long-term risks of infection and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs result in thrombosis of the blood vessel, and this markedly increases the risk of infection. Only one-third of these clots are symptomatic.Within days of insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days, most CVC-related thrombi arise. Aside from reducing the function of the catheter, these CVC-related thrombi can cause postphlebitic syndrome in 15%-30% of cases and pulmonary embolism in 11% (only half of which are symptomatic).Risk factors for CVC thrombosis include the type of malignancy, type of chemotherapy, type of CVC, and locations of insertion site and catheter tip, but not inherited thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic prophylactic anticoagulation with lowmolecular-weight heparin have failed. Low-dose warfarin prophylaxis remains controversial; all studies are flawed, with older studies, but not newer ones, showing benefit.Currently, less than 10% of patients with CVCs receive any systemic prophylaxis. Although its general use cannot be recommended, low-dose warfarin may be a low-risk treatment in patients with good nutrition and adequate hepatic function. Clearly, additional studies are required to substantiate the prophylactic use of low-dose warfarin. Newer anticoagulant treatments, such as pentasaccharide and direct thrombin inhibitors, need to be explored to address this major medical problem.

show abstract

“…Once again, tPA is the most commonly used agent; however, use of urokinase and recombinant urokinase (rUK) have also been reported. [239][240][241][242][243][244][245][246][247][248] …”

Section: Adverse Effectsmentioning

confidence: 99%

“…Both tPA and urokinase have been shown to restore patency in 50% to 90% of CVADs; tPA has been increasingly used relative to urokinase in children during the past decade in doses ranging from 0.1 to 2 mg. Studies have included few neonates. [239][240][241][242][243][244][245][246][247][248] There are no published studies comparing the use of intermittent local thrombolysis as primary prophylaxis for CVAD patency. There are no studies that consider the use of systemic heparin or LMWH as primary prophylaxis for CVADs in neonates as distinct from older children.…”

Section: Thromboprophylaxis For Stage 1 Norwood Proceduresmentioning

confidence: 99%