scholarly journals Central venous catheter–related thrombosis

Hematology ◽  
2014 ◽  
Vol 2014 (1) ◽  
pp. 306-311 ◽  
Author(s):  
William Geerts
Keyword(s):  
Venous Catheter ◽  
Central Venous ◽  
Patients With Cancer ◽  
Central Venous Stenosis ◽  
Thrombosis Risk ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Continued Use ◽  
Catheter Related Thrombosis

Abstract Thrombotic complications associated with the use of central venous catheters (CVCs) are common and lead to distressing patient symptoms, catheter dysfunction, increased risk of infections, long-term central venous stenosis, and considerable costs of care. Risk factors for catheter-related thrombosis include use of larger, multilumen, and peripherally inserted catheters in patients with cancer receiving chemotherapy. Symptomatic catheter-related thrombosis is treated with anticoagulation, generally without removing the catheter. The intensity and duration of anticoagulation depend on the extent of thrombosis, risk of bleeding, and need for continued use of a CVC. To date, the clinical benefit of prophylactic doses of anticoagulant has been disappointing and these agents are not used routinely for this purpose. This chapter focuses on recent evidence, remaining controversies, and practical approaches to reducing the burden of thrombosis associated with CVCs.

D-dimer from central and peripheral blood samples in asymptomatic central venous catheter-related thrombosis in patients with cancer

2018 ◽  
Vol 34 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Homero Nañez-Terreros ◽  
Jose C Jaime-Perez ◽  
Linda E Muñoz-Espinoza ◽  
Carlos R Camara-Lemaroy ◽  
Gerardo E Ornelas-Cortinas ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Blood ◽  
Venous Catheter ◽  
Central Venous ◽  
False Negatives ◽  
Altman Plot ◽  
Patients With Cancer ◽  
Peripheral Samples ◽  
Catheter Related Thrombosis ◽  
D Dimer

Objectives To evaluate the usefulness of a negative D-dimer in peripheral or central venous blood to screen for asymptomatic catheter-related thrombosis in cancer patients. Methods D-dimer was measured in blood from central venous catheter and peripheral venous samples in 48 patients with cancer. Asymptomatic catheter-related thrombosis was identified via Doppler ultrasound. Bland and Altman’s limits of agreement analysis was used to compare sample sites. Sensitivity and specificity of D-dimer was calculated. Results Overall, 33 of the central samples and 32 of the peripheral samples had D-dimer levels below the cutoff (≥0.3 mg/l). Mean central D-dimer was 0.31 ± 0.35 mg/l; peripheral 0.24 ± 0.22 mg/l (p = 0.5). Bland–Altman plot showed that the two sample sites were not equivalent. Catheter-related thrombosis was demonstrated in five patients, and there were three false negatives. Peripheral D-dimer had a negative predictive value of 90.9%. Conclusions A negative D-dimer may be useful for screening asymptomatic catheter-related thrombosis in patients with cancer, but the central and peripheral sample sites are not equivalent.

scholarly journals Central Venous Catheter Thrombosis in Cancer: A Multi-Centre Retrospective Study Investigating Risk Factors and Contemporary Trends in Management

2020 ◽  
Vol 14 ◽  
pp. 117955492095309
Author(s):  
Lucy Haggstrom ◽  
Gurdeep Parmar ◽  
Daniel Brungs
Keyword(s):  
Body Mass Index ◽  
Central Venous Catheter ◽  
Body Mass ◽  
Central Venous Access ◽  
Oral Anticoagulants ◽  
Venous Catheter ◽  
Patient Treatment ◽  
Central Venous ◽  
Increased Risk ◽  
Catheter Related Thrombosis

Objectives: Central venous access is needed to facilitate chemotherapy for many cancer patients. Central venous catheter-related thrombosis (CVCT) is a major complication that can cause significant morbidity and mortality. We sought to explore the rate of CVCT in a general cancer population in Australia and to identify factors associated with increased risk of thrombosis. Design: This is a multi-centre retrospective cohort study. Setting and participants: We analysed key patient, treatment, and cancer-related factors for 317 patients with cancer and central venous catheters inserted for systemic therapy. Main outcome measures: Symptomatic CVCT confirmed with imaging and management of patients with CVCT. Results: A total of 402 cases of central line insertion were analysed. Central venous catheter-related thrombosis occurred in 24 patients (6.0%). Having a peripherally inserted central catheter (PICC; HR = 3.78, 95% CI = 1.28-11.19, P = .02) compared with an implantable port and a body mass index of ⩾25.0 kg/m2 (HR = 3.60, 95% CI = 1.31-9.85, P = .01) were independently associated with increased risk of thrombosis. Central venous catheter-related thrombosis was managed mostly with removal of the catheter (19 of 24 cases) and anticoagulation, including direct-acting oral anticoagulants in 5 patients. Conclusions: This work explored rates of CVCT in a general cancer population, observing increased rates in those with PICCs or increased body mass index.

Management of Hereditary Hypercoagulable Disorders

Hematology ◽  
2006 ◽  
Vol 2006 (1) ◽  
pp. 444-449 ◽  
Author(s):  
Paula L. Bockenstedt
Keyword(s):  
Venous Thromboembolism ◽  
Venous Catheter ◽  
Dialysis Access ◽  
Benefit Analysis ◽  
Central Venous ◽  
Hereditary Factors ◽  
Thrombophilia Screening ◽  
Thrombotic Complications ◽  
Risk Benefit Analysis

Abstract The clinical management of individuals with hereditary hypercoaguable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism to a more intricate individualized risk-benefit analysis as studies have begun to delineate the complexity of interactions of acquired and hereditary factors which determine the predilection to thrombosis. The contribution of thrombophilic disorders to risk of thrombotic complications of pregnancy, organ transplantation, central venous catheter and dialysis access placement have been increasingly recognized. The risk of thrombosis must be weighed against risk of long-term anticoagulation in patients with venous thromboembolism. Thrombophilia screening in select populations may enhance outcome.

scholarly journals Clinical Course and Complications of Catheter and Non-Catheter-Related Upper Extremity Deep Vein Thrombosis in Patients with Cancer

2018 ◽  
Vol 24 (8) ◽  
pp. 1234-1240 ◽  
Author(s):  
Asem Mansour ◽  
Salwa S. Saadeh ◽  
Nayef Abdel-Razeq ◽  
Omar Khozouz ◽  
Mahmoud Abunasser ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Central Venous Catheter ◽  
Upper Extremity ◽  
Clinical Course ◽  
Vena Cava ◽  
Venous Catheter ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Increased Risk

Patients with cancer have an increased risk of venous thromboembolism. Upper extremity venous system is a peculiar site, and little is known about the clinical course in patients with cancer. Electronic medical records were searched for patients with cancer with a diagnosis of upper extremity venous thrombosis. Individual patient data were reviewed. Eighty-seven patients were identified, and the median age was 52.4. The most common underlying malignancies were breast (23.0%), colorectal (18.4%), and gastroesophageal (18.4%). Median time from cancer diagnosis to upper extremity venous thromboembolism (UEDVT) was 3.44 months. Subclavian vein was the most common involved site (56.3%) and 54.0% patients had a central venous catheter; 50.6% of patients developed a complication; pulmonary embolism (PE) in 9.2%, superior vena cava (SVC) syndrome in 14.9%, and 26.4% had postthrombotic syndrome. In patients with isolated single vein thrombosis, complications were higher in the subset with internal jugular vein involvement compared to other sites (68.2% vs 52.2%) as were complications in patients with non-catheter-related thrombosis compared to patients with a central venous catheter in place (55% vs 27.7%). Median overall survival from time of cancer and UEDVT diagnoses was 29.6 and 13.25 months, respectively. In conclusion, UEDVT is an uncommon event. Around 50% developed a complication including PE, SVC or postthrombotic syndromes. Larger studies are needed to better identify risks associated with thrombosis and the best therapeutic approach and duration in this unique subset of patients with cancer.

scholarly journals Long-Term Central Venous Catheter Use and Risk of Infection in Older Adults With Cancer

2014 ◽  
Vol 32 (22) ◽  
pp. 2351-2356 ◽  
Author(s):  
Allison Lipitz-Snyderman ◽  
Kent A. Sepkowitz ◽  
Elena B. Elkin ◽  
Laura C. Pinheiro ◽  
Camelia S. Sima ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Pancreatic Cancer ◽  
Infection Risk ◽  
Care Quality ◽  
Central Venous ◽  
Patients With Cancer ◽  
Increased Risk ◽  
The Impact

Purpose Long-term central venous catheters (CVCs) are often used in patients with cancer to facilitate venous access to administer intravenous fluids and chemotherapy. CVCs can also be a source of bloodstream infections, although this risk is not well understood. We examined the impact of long-term CVC use on infection risk, independent of other risk factors such as chemotherapy, in a population-based cohort of patients with cancer. Patients and Methods We conducted a retrospective analysis using SEER-Medicare data for patients age > 65 years diagnosed from 2005 to 2007 with invasive colorectal, head and neck, lung, or pancreatic cancer, non-Hodgkin lymphoma, or invasive or noninvasive breast cancer. Cox proportional hazards regression was used to examine the relationship between CVC use and infections, with CVC exposure as a time-dependent predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results CVC exposure was associated with a significantly elevated infection risk, adjusting for demographic and disease characteristics. For patients with pancreatic cancer, risk of infections during the exposure period was three-fold greater (adjusted hazard ratio [AHR], 2.93; 95% CI, 2.58 to 3.33); for those with breast cancer, it was six-fold greater (AHR, 6.19; 95% CI, 5.42 to 7.07). Findings were similar when we accounted for propensity to receive a CVC and limited the cohort to individuals at high risk of infections. Conclusion Long-term CVC use was associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs and targeted strategies for reducing infections are critical to improving cancer care quality.

Neonatal haemostasis

2016 ◽  
Vol 36 (04) ◽  
pp. 261-264 ◽  
Author(s):  
Shoshana Revel-Vilk
Keyword(s):  
Venous Catheter ◽  
Coagulation System ◽  
Hospitalized Children ◽  
Reference Ranges ◽  
Bleeding Diathesis ◽  
Older Children ◽  
Central Venous ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Hemostatic Disorders

SummaryThe maturation and postnatal development of the human coagulation system results in significant and important differences in the coagulation and fibrinolysis of neonates and young children compared to older children and adults. Importantly, these differences, which mostly reflect the immaturity of the neonatal haemostasis system, are functionally balanced. Healthy neonates show no signs of easy bruising or other bleeding diathesis and no increased tendency to thrombosis for any given stimulus compared to adults.Systemic diseases may affect haemostasis, thus predisposing ill neonates to increased risk for haemorrhagic or thrombotic complications. In hospitalized children, neonates have increased risk of developing thrombosis compared to infants and children, mostly associated with the presence of central venous catheter. For diagnosis of haemostasis disorders, diagnostic laboratories processing pediatric samples should use age, analyzer and reagent appropriate reference ranges. Age specific guidelines should be followed for the management of neonates with hemostatic disorders.

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