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Doppler evaluation of central venous lines in the superior vena cava
1Division of Cardiology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
Insights
Color flow Doppler effectively detects superior vena cava (SVC) thrombus, a complication of central venous catheters. Altered SVC blood flow patterns, including turbulence and velocity changes, indicate thrombus formation or obstruction.
Area of Science:
- Cardiovascular Imaging
- Vascular Ultrasound
- Interventional Cardiology
Background:
- Thrombus formation in the superior vena cava (SVC) is a significant complication associated with central venous catheter use.
- Diagnosing SVC thrombus using traditional two-dimensional echocardiography can be challenging due to visualization difficulties.
Purpose of the Study:
- To evaluate the utility of color flow Doppler in assessing superior vena cava (SVC) blood flow before and after central venous catheter placement.
- To determine if color flow Doppler can identify thrombus or obstruction in the SVC.
Main Methods:
- Color flow Doppler examinations were performed on 12 patients before and within 48 hours of central venous catheter insertion.
- Five additional patients with suspected SVC thrombus or obstruction underwent Doppler evaluation.
Main Results:
- Normal SVC flow exhibited two distinct peaks, respiratory variability, and velocities between 0.5-1.5 m/sec, unaffected by catheters.
- Patients with thrombus or obstruction showed turbulent flow, loss of biphasic profile, and altered velocities (increased downstream, decreased upstream).
Conclusions:
- Color flow Doppler is a valuable adjunct to echocardiography for evaluating catheter-related SVC thrombus.
- An altered SVC flow profile, particularly increased velocity, suggests the presence of thrombus or obstruction.
Abstract:
Thrombus formation in the superior vena cava (SVC) complicates the use of central venous catheters. Visualizing the thrombus by two-dimensional echo-cardiography is often difficult. Flow in the SVC can be recorded by using color flow Doppler examinations. Hence SVC flow was evaluated by color flow Doppler in 12 patients before and within 48 hours of central venous catheters. Five patients with catheters in their SVCs, with suspected thrombus or obstruction to the SVC, were also studied. The SVC flow in the subjects before catheter placement was characterized by two distinct peaks, respiratory variability, and maximal velocities between 0.5 and 1.5 m/sec; these were unchanged by the catheters. The five patients with thrombus or obstruction had turbulent flow, loss of a distinct biphasic profile, and increased velocity downstream to the thrombus and decreased velocity upstream. It appears that Doppler study is a worthwhile adjunct to two-dimensional echocardiography in the evaluation of catheter-related thrombus, and that an altered SVC flow profile with increased velocity suggests thrombus formation or obstruction or both.