Superior vena cava thrombosis related to catheter malposition in cancer chemotherapy given through implanted ports

Abstract

Background. Thrombosis of the central veins is one of the most frequent complications of implanted venous access devices. Among the first cases occurring in our patients, most were associated with left‐sided placement of the ports, with catheter tips lying against the external wall in the upper half of the superior vena cava. Some chest radiographs showed lateromediastinal opacities centered on the catheter tip, suggesting a vessel injury. This position allows a narrow contact between the catheter tip and the vessel wall, thus endothelial injuries might result from mechanical and chemical attack. Methods. To assess the role of catheter position, we reviewed the routine chest radiographs of 379 patients who received chemotherapy through venous access devices and were followed up at our department between December 1985 and December 1990. Four groups (upper left, upper right, lower left, and lower right) were defined according to the level of the catheter tip (innominate veins or upper half of the vena cava versus lower half of the vena cava or auricula) and to the side of port implantation. Results. Ten patients developed symptomatic venous thrombosis (superior vena cava in 9 patient, left subclavian vein in 1 patient). A strong correlation existed between catheter position and incidence of thrombosis: upper left, 8/28 (28.6%); upper right, 1/33 (3%); lower right, 1/68 (1.5%); and lower left, 0/250. Since 1988, we have insisted on replacement of malpositioned catheters, and we have observed fewer thromboses (2/191 versus 8/188). Conclusions. The current study suggests that patients with left‐sided ports and catheter tips lying in the upper part of the vena cava are at high risk for severe thrombotic complications.

Subcutaneously implanted central venous access devices in cancer patients

“…Catheter tip position above the T3 level, especially with left subclavian vein prior study previous device failure was not a predictor for subsequent device failure, 1 the authors chose to cannulation, has been implicated as a major risk factor for thrombosis. 16 The current data support the imporfocus this analysis on the total number of devices placed rather than the individual patients who retance of proper tip position, because a catheter tip outside the superior vena cava or right atrium was ceived a device.…”

Late Vascular Occlusion of Central Lines in Pediatric Malignancies

“…Notably, none of the 3 patients who had persistent thrombi received hyperalimentation. Other studies suggest that risk factors for thrombotic complications include the diagnosis of acute lymphocytic leukemia, 8 (which represented only 8% of our sample), treatment with asparaginase, 16 malposition of the catheter, 17 or large catheter diameter. 18 Prospective studies of large numbers of patients are necessary to determine the true incidence of both acute and, particularly, late complications of CVLrelated thrombosis, predisposing conditions, and the potential role of prevention with anticoagulation or other therapies.…”

Risk factors for catheter-related thrombosis in cancer patients

“…While several factors may contribute to the development of venous thrombosis, few of these factors have been examined in well-controlled studies [8,9]. We therefore investigated various risk factors and the incidence of catheter-related thrombosis in a cohort of cancer patients undergoing chemotherapy and determined the risk of catheter-related thrombosis associated with anticoagulant treatment and prothrombotic risk factors.…”