scholarly journals Is There Any Association between PEEP and Upper Extremity DVT?

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Farah Al-Saffar ◽  
Ena Gupta ◽  
Furqan Siddiqi ◽  
Muhammad Faisal ◽  
Lisa M. Jones ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Duplex Ultrasound ◽  
Venous Catheter ◽  
Venous Stasis ◽  
Retrospective Case ◽  
Vein Thrombosis ◽  
Medical Intensive Care ◽  
The Mean ◽  
Deep Vein ◽  
Control Study

Background. We hypothesized that positive end-exploratory pressure (PEEP) may promote venous stasis in the upper extremities and predispose to upper extremity deep vein thrombosis (UEDVT).Methods. We performed a retrospective case control study of medical intensive care unit patients who required mechanical ventilation (MV) for >72 hours and underwent duplex ultrasound of their upper veins for suspected DVT between January 2011 and December 2013.Results. UEDVT was found in 32 (28.5%) of 112 patients. Nineteen (67.8%) had a central venous catheter on the same side. The mean ± SD duration of MV was13.2±9.5days. Average PEEP was7.13±2.97 cm H2O. Average PEEP was ≥10 cm H2O in 23 (20.5%) patients. Congestive heart failure (CHF) significantly increased the odds of UEDVT (OR 4.53, 95% CI 1.13–18.11;P=0.03) whereas longer duration of MV (≥13 vs. <13 days) significantly reduced it (OR 0.29, 95% CI 0.11–0.8;P=0.02). Morbid obesity showed a trend towards significance (OR 3.82, 95% CI 0.95–15.4;P=0.06). Neither PEEP nor any of the other analyzed predictors was associated with UEDVT.Conclusions. There is no association between PEEP and UEDVT. CHF may predispose to UEDVT whereas the risk of UEDVT declines with longer duration of MV.

Catheter-Associated Deep Vein Thrombosis (CADVT) in a Pediatric ICU: A Retrospective Case-Control Study

2020 ◽  
Vol 25 (3) ◽  
pp. 45-55
Author(s):  
Sandeep Tripathi ◽  
Kimberly Burkiewicz ◽  
Jonathan A. Gehlbach ◽  
Yanzhi Wang ◽  
Michele Astle
Keyword(s):  
Deep Vein Thrombosis ◽  
Central Venous Catheter ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Retrospective Case ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Control Study

Highlights Abstract Introduction: Catheter-associated deep vein thrombosis (CADVT) in children has been recognized as a significant hospital-acquired condition. This study was undertaken to retrospectively analyze the impact of CADVT on outcomes and to identify risk factors for the development of deep vein thrombosis in children with central venous catheters. Methods: This was a single-center retrospective case-control study of patients with central venous catheters in a pediatric intensive care unit (ICU) from January 2014 to December 2018. Forty-one patients with central venous catheters who developed CADVT were compared with 100 random controls. Central venous catheter type, along with patient and disease-specific characteristics, were compared between the two groups by univariate and multivariate regression. Outcome comparison was made after adjusting for confounding variables. Results: Median time from insertion to the development of CADVT was 4 days (interquartile range, 2–9). Forty percent (16/40) of patients had a blood urea nitrogen greater than 20 mg/dL, and 86.6% (13/15) had a C-reactive protein greater than 1 mg/dL within 48 hours of development of CADVT. Central venous catheter duration (odds ratio [OR], 1.05), mechanical ventilation (OR, 7.49), and upper versus lower extremity site of the central venous catheter (OR, 0.324) were associated with the development of CADVT. Ultrasound guidance occurred significantly less in patients who developed CADVT (39.3% vs 70.7%); however, it was not independently associated with increased risk. Age, body mass index, mechanical ventilation, and severity of illness–adjusted hospital and ICU length of stay were significantly higher in patients who developed CADVT. Conclusions: CADVT is independently associated with worse outcomes. Ultrasound guidance and site selection are potential modifiable risk factors in the development of CADVT in pediatric patients. Future studies should target an effective chemoprophylaxis regimen.

scholarly journals Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Michael Blaivas ◽  
Konstantinos Stefanidis ◽  
Serafim Nanas ◽  
John Poularas ◽  
Mitchell Wachtel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Upper Extremity ◽  
Strong Predictor ◽  
Venous Catheter ◽  
Acute Thrombosis ◽  
Vein Thrombosis ◽  
Therapeutic Anticoagulation ◽  
Deep Vein ◽  
Critical Care Patients

Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting.Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers.Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716,P=0.007)], malignancy (OR 1.483,P=0.036), total parenteral nutrition (OR 1.399,P=0.035), hypercoagulable state (OR 1.284,P=0.045), and obesity (OR 1.191,P=0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined.Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.

Central venous catheters and upper-extremity deep-vein thrombosis complicating immune heparin-induced thrombocytopenia

Blood ◽  
2003 ◽  
Vol 101 (8) ◽  
pp. 3049-3051 ◽  
Author(s):  
Aaron P. Hong ◽  
Deborah J. Cook ◽  
Christopher S. Sigouin ◽  
Theodore E. Warkentin
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Orthopedic Surgery ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Heparin Induced Thrombocytopenia ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis

Abstract Heparin-induced thrombocytopenia (HIT) is a transient antibody-mediated hypercoagulability state strongly associated with lower-limb deep-vein thrombosis (DVT). Whether HIT is additionally associated with upper-limb DVT—either with or without central venous catheter (CVC) use—is unknown. We therefore studied 260 patients with antibody-positive HIT to determine the influence of CVC use on frequency and localization of upper-extremity DVT in comparison with 2 non-HIT control populations (postoperative orthopedic surgery and intensive-care unit patients). Compared with the control populations, both upper- and lower-extremity DVTs were found to be associated with HIT. Upper-extremity DVTs occurred more frequently in HIT patients with a CVC (14 of 145 [9.7%]) versus none of 115 (0%) patients without a CVC (P = .000 35). All upper-extremity DVTs occurred at the CVC site (right, 12; left, 2; kappa = 1.0; P = .011). We conclude that a localizing vascular injury (CVC use) and a systemic hypercoagulability disorder (HIT) interact to explain upper-extremity DVT complicating HIT.

Treatment of upper-extremity outflow thrombosis

2016 ◽  
Vol 31 (1_suppl) ◽  
pp. 28-33 ◽  
Author(s):  
Marijn ML van den Houten ◽  
Regine van Grinsven ◽  
Sjaak Pouwels ◽  
Lonneke SF Yo ◽  
Marc RHM van Sambeek ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Venous Catheter ◽  
Transluminal Angioplasty ◽  
Initial Management ◽  
Vein Thrombosis ◽  
Aggressive Management ◽  
Catheter Directed Thrombolysis ◽  
First Rib Resection ◽  
Deep Vein ◽  
Percutaneous Transluminal

Approximately 10% of all cases of deep vein thrombosis (DVT) occur in the upper extremities. The most common secondary cause of upper-extremity DVT (UEDVT) is the presence of a venous catheter. Primary UEDVT is far less common and usually occurs in patients with anatomic abnormalities of the costoclavicular space causing compression of the subclavian vein, called venous thoracic outlet syndrome (VTOS). Subsequently, movement of the arm results in repetitive microtrauma to the vein and its surrounding structures causing apparent ‘spontaneous’ thrombosis, or Paget-Schrötter syndrome. Treatment of UEDVT aims at elimination of the thrombus, thereby relieving acute symptoms, and preventing recurrence. Initial management for all UEDVT patients consists of anticoagulant therapy. In patients with Paget-Schrötter syndrome the underlying VTOS necessitates a more aggressive management strategy. Several therapeutic options exist, including catheter-directed thrombolysis, surgical decompression through first rib resection, and percutaneous transluminal angioplasty of the vein. However, several controversies exist regarding their indication and timing.

Upper Extremity Deep Vein Thrombosis - Incidence, Risk Factors, and Management. The Worcester Venous Thromboembolism Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 584-584
Author(s):  
Frederick A. Spencer3 ◽  
Robert J. Goldberg ◽  
Darleen Lessard ◽  
Cathy Emery ◽  
Apar Bains ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Central Venous Catheter ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Venous Catheter ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background: Recent observations suggest that upper extremity deep vein thrombosis (DVT) has become more common over the last few decades. However the prevalence of this disorder within the community has not been established. The purpose of this study was to compare the occurrence rate, risk factor profile, management strategies, and hospital outcomes in patients with upper versus lower extremity DVT in a cohort of all Worcester residents diagnosed with venous thromboembolism (VTE) in 1999. Methods: The medical records of all residents from the Worcester, MA statistical metropolitan area (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible DVT and/or pulmonary embolism at all 11 Worcester hospitals during the years 1999, 2001, and 2003 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. Results: A total of 483 cases have been validated as acute DVT events - this represents all cases of DVT occurring in residents of the Worcester SMSA in 1999. For purposes of this analysis we have excluded 4 patients with both upper and lower extremity DVT. Upper extremity DVT was diagnosed in 68 (14.2%) of patients versus 411 (85.8%) cases of lower extremity DVT. Patients with upper extremity DVT were younger, more likely to be Hispanic, more likely to have renal disease and more likely to have had a recent central venous catheter, infection, surgery, ICU stay, or chemotherapy than patients with lower extremity DVT. They were less likely to have had a prior DVT or to have developed their current DVT as an outpatient. Although less likely to be treated with heparin, LMWH, or warfarin they were more likely to suffer major bleeding complications. Recurrence rates of VTE during hospitalization were very low in both groups. Conclusions: Patients with upper extremity DVT comprise a small but clinically important proportion of all patients with DVT in the community setting. Their risk profiles differs from patients with lower extremity DVT suggesting strategies for DVT prophylaxis and treatment for this group may need to be tailored. Characteristics of Patients with Upper versus Lower Extremity DVT Upper extremity (n=68) Lower extremity (n=417) P value *Recent = < 3 months Demographics Mean Age, yrs 59.3 66.5 <0.001 Male (%) 51.5 45 NS Race (%) <0.05 White 86.6 91.6 Black 1.5 3.2 Hispanic 9.0 2.0 VTE Setting (%) <0.001 Community 53.8 76.2 Hospital Acquired 46.2 23.8 Risk Factors (%) Recent Central Venous Catheter 61.8 11.9 <0.001 Recent Infection 48.5 32.4 <0.01 Recent Surgery 47.8 28.1 <0.001 Cancer 44.1 32.6 0.06 Recent Immobility 38.2 47.0 NS Recent chemotherapy 25 9.5 <0.001 Renal disease 23.5 1.7 <0.0001 Recent ICU discharge 23.5 15.1 0.07 Recent CHF 19.1 16.6 NS Previous DVT 3.0 18.7 <0.01 Anticoagulant prophylaxis (%) During hospital admission (n=125) 76.7 71.6 NS During recent prior hospital admission (n=188) 73.7 54.7 <0.05 During recent surgery (n=146) 62.5 55.3 NS Hospital therapy - treatment doses (%) Any heparin/LMWH 66.2 82 <0.01 Warfarin at discharge 53.1 71.2 <0.01 Hospital Outcomes (%) Length of stay (mean, d) 11.2 6.8 <0.01 Major bleeding 11.8 4.9 <0.05 Recurrent DVT 1.5 1.0 NS Recurrent PE 0 0.2 NS Hospital Mortality 4.5 4.1 NS

scholarly journals The Incidence of Post-Thrombotic Syndrome after the Treatment of Upper Extremity Deep Vein Thrombosis with Oral Rivaroxaban

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2530-2530
Author(s):  
Kirill Lobastov ◽  
Victor Barinov ◽  
Iliya Schastlivtsev ◽  
Leonid Laberko ◽  
Grigory Rodoman ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Major Bleeding ◽  
Individual Risk ◽  
Minor Bleeding ◽  
Duration Of Symptoms ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
The Mean ◽  
Deep Vein

Abstract Aim: To assess oral rivaroxaban's efficacy and safety in the treatment of upper extremity deep vein thrombosis (UEDVT). Methods: This was a prospective observational study involving patients with their first UEDVT episodes confirmed by duplex ultrasound (DUS) without symptoms of pulmonary embolism (PE). All patients initially received low-molecular-weight heparin for 1 to 2 days and were then switched to oral rivaroxaban (15 mg bid) for three weeks and then to 20 mg qid for up to three months. Patients who had already undergone interventional UEDVT treatment were excluded. Patients were followed up with clinical examination and DUS for six months. The endpoints of the study were symptomatic PE, recurrent UEDVT, major, clinically relevant non-major and minor bleeding, recanalization of the affected veins, recognized as a blood flow with DUS, post-thrombotic syndrome (PTS) incidence of the affected limb assessed by modified Villata score by Czihal. Results: A total of 30 patients (13 men and 17 women) aged 28-78 years (mean age 52.4 ± 17.3) were included in the study. Some (16.7%) of them had undergone physical exertion which triggered the UEDVT. In 13.3%, there was a pacemaker previously implanted through the affected limb. Also, patients had from 0 to 5 individual risk factors for venous thromboembolism (mean 1.9±1.6). The subclavian vein, predominantly on the right side (60%), was involved in the thrombotic process in all cases. The mean duration of symptoms before diagnosis was 1.8±1.7 days. All 30 patients were followed for six months. There were no episodes of symptomatic PE and/or recurrent UEDVT during the period of anticoagulation (0-3 months) and after stop of treatment (3-6 months). No episodes of major bleeding were observed. Clinically relevant non-major bleeding occurred in 2 patients (6.7%: 95% confidence interval [CI]: 1.9-21.4%) caused by uterine bleeding and large skin hemorrhage. Minor bleeding was observed in two patients (6.7%: 95% CI: 1.9-21.4%) caused by nasal and gingival bleeding. Thus, cumulative bleeding incidence was 13.4% (95% CI: 5.4-29.8%). Recanalization of upper extremity deep veins was observed in all affected limbs at three months and persist up to six months. The signs of upper limbs PTS (≥5 modified Villalta score) were found in four patients (13.4 %; 95% CI: 5.4-29.8%), and the mean score was 2.1±1.9. Conclusion: Treatment of UEDVT with oral rivaroxaban seems to be effective, safe, and associated with the low incidence of upper limb PTS. Disclosures Lobastov: Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Barinov:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Schastlivtsev:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau.

scholarly journals Upper Extremity Thrombosis Presenting as Medial Elbow Pain after Shoulder Arthroscopy

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Moiz I. Manaqibwala ◽  
Irene E. Ghobrial ◽  
Alan S. Curtis
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Shoulder Arthroscopy ◽  
Duplex Ultrasound ◽  
Elbow Pain ◽  
True Incidence ◽  
Vein Thrombosis ◽  
Ultrasound Evaluation ◽  
Arthroscopic Shoulder Surgery ◽  
Deep Vein

Deep vein thrombosis of the upper extremity is believed to be an uncommon complication of arthroscopic shoulder surgery. It most commonly presents with significant swelling and pain throughout the upper extremity. However the diagnosis can be easily missed when findings are more subtle and unrelated or the patient asymptomatic. In this study we report on 5 cases of postoperative upper extremity deep vein thrombosis (UEDVT). Each case was performed in the lateral decubitus position with an interscalene block and postoperative sling immobilization. All patients presented with a primary complaint of medial elbow pain and went on to require anticoagulation. Only one patient was found to have a heritable coagulopathy. The true incidence of thromboembolic phenomena after shoulder arthroscopy may be higher than that reported in the current literature. Therefore a high index of suspicion must be maintained when evaluating patients postoperatively to avoid misdiagnosis. Symptoms of medial elbow pain after immobilization in a sling should be considered an indication for duplex ultrasound evaluation. Ultimately, further prospective study is needed to better understand the prevalence, prevention, and management of this entity.

Outcome of central venous catheter associated upper extremity deep vein thrombosis in cancer patients

2015 ◽  
Vol 135 (2) ◽  
pp. 298-302 ◽  
Author(s):  
Aurélien Delluc ◽  
Grégoire Le Gal ◽  
Dimitrios Scarvelis ◽  
Marc Carrier
Keyword(s):  
Deep Vein Thrombosis ◽  
Central Venous Catheter ◽  
Cancer Patients ◽  
Upper Extremity ◽  
Venous Catheter ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Deep Vein

Upper Extremity Phlegmasia Cerula Dolens: Presentation by Color Duplex Ultrasound

2003 ◽  
Vol 27 (1) ◽  
pp. 35-38
Author(s):  
Nancy Tuvell ◽  
Kelly Bates ◽  
Kathryn Sorrell
Keyword(s):  
Upper Extremity ◽  
Duplex Ultrasound ◽  
Open Lung Biopsy ◽  
Vein Thrombosis ◽  
Right Hand ◽  
Superficial Vein Thrombosis ◽  
Doppler Signals ◽  
The Right ◽  
Deep Vein ◽  
Color Duplex Ultrasound

Introduction Phlegmasia cerula dolens (PCD) is an uncommon complication of deep vein thrombosis (DVT), and involvement in the upper extremities is rare. We report a case in which color duplex ultrasound (CDU) was used to diagnose PCD in a patient with extensive upper extremity DVT. Patient A 57-year-old woman underwent an open lung biopsy. On the first postoperative day, she had right hand and forearm pain, edema, and cyanosis. Findings CDU revealedacute DVT in the right radial, ulnar, and brachial veins and extensive thrombosis of the right cephalic and basilic veins. Arterial signals recorded from the ipsilateral arteries were remarkable for pandiastolic flow reversal (PDFR). In contrast, arterial signals from the contralateral arm had a normal, triphasic pattern. Arteriography revealed patent arteries to the wrist and no flow present in the right hand. Conclusions This report demonstrates the sensitivity of CDU to arterial compromise associated with PCD in a case of upper extremity DVT. Vascular technologists should consider including arterial Doppler signals in their venous duplex protocols in cases of extensive deep and superficial vein thrombosis.

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