Peripheral IV Catheter-Associated Upper Extremity Deep Vein Thrombosis in a Patient with Psychiatric Illness: A Case...

Upper-extremity deep vein thrombosis (UEDVT) is relatively uncommon accounting for roughly 4-10% of all deep vein thromboses but its incidence is rising, largely due to the widespread utilization of intravenous catheters. While central venous catheters are the typical culprits, peripheral IV cannulas are not benign and may provoke thrombosis via local endothelial trauma and venous stasis, especially in individuals with systemic prothrombotic predispositions.

We report a 44-year-old man with bipolar affective disorder on haloperidol, promethazine, and carbamazepine. Five days after placement of a peripheral IV cannula in his right forearm, he developed gradually worsening pain and swelling from the mid-forearm extending into the upper arm. Duplex ultrasonography revealed occlusive thrombus in the antecubital vein, confirming catheter-associated UEDVT.

The patient was initially started on low molecular weight heparin, later transitioned to apixaban. His symptoms resolved within three weeks, and after three months of anticoagulation with normalization of D-dimer levels therapy was discontinued without recurrence.

Even peripheral IV cannulation may precipitate UEDVT when combined with local vein injury and systemic hypercoagulability. Antipsychotics, such as haloperidol and chlorpromazine, may further elevate thrombosis risk. Clinicians must maintain vigilance for UEDVT in patients with unilateral arm swelling post-cannulation, recognizing that prompt ultrasound evaluation and guideline-based anticoagulation are essential to prevent complications.