Subclavian Venous Thrombosis Due to Indwelling Catheters: A Prospective Study on 52 Patients

Abstract

Clinical occurrence of subclavian venous thrombosis due to indwelling catheters is rare, but there is some evidence that subclinical thrombosis frequently occurs. It is purpose of this study to report the results of a prospective investigation in patients with subclavian vein catheters. Fifty-two patients admitted to the Istituto Nazionale Tumori of Milan and candidate to infraclavicular percutaneous catheterization of the subclavian vein were evaluated. There were 26 polyvinyl chloride and 26 rubber silicone catheters, which were correctly positioned in the superior vena cava-atrium. Average duration of the intravenous stay was 12.8 days. Asymptomatic thrombosis was venographically demonstrated in 46.1% of the polyvinyl chloride catheters and in 11.5% of the silicone ones (p = 0.005). The average age of catheters with or without thrombosis was 10.8 and 13.8 days, respectively. Addition of heparin to the infusate (1 U/ml) did not reduce the thrombosis rate in polyvinyl chloride or in silicone catheters, but risk of thrombosis was significantly higher (p = 0.03) in polyvinyl chloride catheters without heparin in comparison to the silicone ones. Osmolarity of the infusional fluid, manipulation during the cannulation, colonization of the catheter tip, and duration of the intravenous stay of the catheter apparently did not influence the rate of thrombosis. Since the natural history of the thrombotic subclavian veins is not known, some caution must be paid to repeat the percutaneous cannulation of the same vein and the change the catheter over a guidewire.

No effect of nadroparin prophylaxis in the prevention of central venous catheter (CVC)-associated thrombosis in bone marrow transplant recipients

“…The rate of thrombosis in our patient population is in concordance with other studies. 4,5 Hickman double-or triple-lumen CVCs were most frequently associated with thrombosis, 9.6% vs 3.7% in single lumen CVCs. However, in the double-or triple-lumen group no effect of nadroparin could be observed either, with 10% thrombosis occurring in patients receiving prophylaxis and 9% in patients taking no prophylaxis.…”

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

“…Using the specified selection criteria, a total of nine prospective studies of thromboprophylaxis use in adult cancer patients with CVC were identified (Table 1) (Bozzetti et al, 1983;Bern et al, 1990;Monreal et al, 1996;Nightingale et al, 1997;Boraks et al, 1998;Heaton et al, 2002;Mismetti et al, 2003;Couban et al, 2005;Verso et al, 2005). Of these studies, one investigated unfractionated heparin thromboprophylaxis, (Bozzetti et al, 1983) while another three studied the efficacy of different low molecular weight heparin preparations (dalteparin, nadroparin and enoxaparin, respectively) (Monreal et al, 1996;Mismetti et al, 2003;Verso et al, 2005).…”

Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients

“…[3][4][5] Routine venography of asymptomatic patients undergoing autologous or allogeneic bone marrow transplantation reveals a thrombosis rate that varies from 4 to 42%. [6][7][8][9][10] A large number of studies have been published addressing the association of inherited prothrombotic abnormalities with deep vein thrombosis of the leg and pulmonary embolism. 11 In contrast, studies in HSCT recipients investigating the association of these risk factors with CVC-related thrombosis are scarce.…”