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[Deep venous thrombosis caused by central venous catheter]
C Lersch1, M Paschalidis, W Theiss
1II. und I. Medizinische Kliniken, Technischen Universität, Klinikum rechts der Isar, München.
Insights
Central venous access catheters can cause infections and thrombosis. Using silicone catheters with tips in the lower vena cava or right atrium minimizes thrombosis risk, especially with pre-op antibiotics and 90-day heparin for high-risk cancer patients.
Area of Science:
- Vascular Surgery
- Oncology
- Infectious Diseases
Context:
- Central venous access catheters and ports are essential in oncological and other treatments.
- Infections and venous thromboses are significant complications associated with these devices.
- Thrombosis rates vary based on catheter type, material, diameter, and tip placement.
Purpose:
- To review the complications of central venous access catheters and ports.
- To identify factors influencing the frequency of catheter-related thrombosis.
- To recommend strategies for preventing and managing thrombosis in patients with central venous access devices.
Summary:
- The lowest rates of thrombotic complications are associated with single or double lumen silicone catheters (Hickman or port catheters) positioned in the lower superior vena cava or right atrium.
- For oncological patients at high risk of thrombosis, preoperative antibiotics and a minimum of 90 days of heparin post-placement are recommended.
- Thrombosis-related catheter occlusion can be managed with low-dose urokinase or streptokinase to restore function; otherwise, treatment aligns with general thrombosis management.
Impact:
- Provides evidence-based recommendations for minimizing central venous catheter complications.
- Informs clinical practice regarding the selection and management of central venous access devices.
- Aims to improve patient safety and treatment outcomes by reducing device-related morbidity.
Abstract:
Infections and venous thromboses are the major complications of central venous access catheters and ports. The frequency of thrombosis depends on the venous access systems used, their material, their diameters and the position of their tips. The lowest rate of thrombotic complications is seen with single or double lumen Hickman- or port catheters made of silicone with their tips in the lower half of the superior vena cava or in the right atrium. Antibiotics given preoperatively and heparin for at least 90 days after catheter placement must be recommended in oncological patients with a high risk of thrombosis. In case of thrombosis-related occlusion of the catheters low-dose urokinase and streptokinase can be helpful to restore the catheter's function. Else, therapy is identical to that of other types of thrombosis.