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      Upper extremity deep vein thrombosis: a complication of an indwelling peripherally inserted central venous catheter

      case-report
      Author(s): ,
      Publication date (Electronic):
      Journal: Clinical Case Reports
      Publisher: BlackWell Publishing Ltd

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          Key Clinical Message

          We report a case of peripherally inserted central venous catheter (PICC)-associated deep vein thrombosis (DVT). Ultrasound images and video of subclavian thrombus are presented. PICC line-associated DVT, particularly in cancer patients is not uncommon. Point-of-care Emergency Department ultrasound can readily diagnose this complication and device removal is not always necessary.

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          Virchow and his triad: a question of attribution.

          Rosemary Bagot, Roopen Arya (2008)
          Virchow's triad describes three factors that contribute to the development of venous thrombosis: hypercoagulability, stasis and endothelial injury. Yet, extensive review of the historical literature casts doubt on the existence of a triad described by Virchow in the form it is currently quoted throughout contemporary medical literature. Certainly his work involved extensive study of venous thrombosis and pulmonary embolism, with these two terms being coined by Virchow, but a triad of factors relating to the development of venous thrombosis is elusive. Interestingly, Virchow only began to be routinely credited with this triad one hundred years after publication of his work on venous thrombosis. This acknowledgement coincided with the accumulation of experimental evidence for the role these factors play in thrombogenesis. Controversial as the origins of Virchow's triad might be, it is apt given his substantial contribution to our knowledge of venous thromboembolism, and the fact that the triad continues to be clinically relevant today that a triad pertaining to Virchow should remain.
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            Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis.

            Vineet Chopra, Sarah Anand, Andy Hickner … (2013)
            Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs. We searched several databases, including Medline, Embase, Biosis, Cochrane Central Register of Controlled Trials, Conference Papers Index, and Scopus. Additional studies were identified through hand searches of bibliographies and internet searches, and we contacted study authors to obtain unpublished data. All human studies published in full text, abstract, or poster form were eligible for inclusion. All studies were of adult patients aged at least 18 years who underwent insertion of a PICC. Studies were assessed with the Newcastle-Ottawa risk of bias scale. In studies without a comparison group, the pooled frequency of venous thromboembolism was calculated for patients receiving PICCs. In studies comparing PICCs with other CVCs, summary odds ratios (ORs) were calculated with a random effects meta-analysis. Of the 533 citations identified, 64 studies (12 with a comparison group and 52 without) including 29 503 patients met the eligibility criteria. In the non-comparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill (13·91%, 95% CI 7·68-20·14) and those with cancer (6·67%, 4·69-8·64). Our meta-analysis of 11 studies comparing the risk of deep vein thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of deep vein thrombosis (OR 2·55, 1·54-4·23, p<0·0001) but not pulmonary embolism (no events). With the baseline PICC-related deep vein thrombosis rate of 2·7% and pooled OR of 2·55, the number needed to harm relative to CVCs was 26 (95% CI 13-71). PICCs are associated with a higher risk of deep vein thrombosis than are CVCs, especially in patients who are critically ill or those with a malignancy. The decision to insert PICCs should be guided by weighing of the risk of thrombosis against the benefit provided by these devices. None. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters.

              Thomas Nifong, Timothy J McDevitt (2011)
              Catheter-related thrombosis is a common complication in all anatomic sites, especially when smaller veins of the upper extremity are considered. It is presumed that the presence of a catheter within the lumen of a vein will decrease flow and potentially create stasis, and clinical data suggest that the size of the catheter impacts thrombosis rates. We sought to determine, both mathematically and experimentally, the impact of catheters on fluid flow rates.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (publisher-id): ccr3
                Title: Clinical Case Reports
                Publisher: BlackWell Publishing Ltd (Oxford, UK )
                ISSN (Print): 2050-0904
                ISSN (Electronic): 2050-0904
                Publication date (Print): March 2015
                Publication date (Electronic): 22 January 2015
                Volume: 3
                Issue: 3
                Pages: 170-174
                Affiliations
                Emergency Medicine, Faculty of Medicine, Dentistry and Health Sciences, School of Primary, Aboriginal and Rural Health Care, University of Western Australia Nedlands, Western Australia, 6009, Australia
                Author notes
                Correspondence Peter J. Carr, Emergency Medicine, Faculty of Medicine, Dentistry and Health Sciences, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, M516, 2nd Floor, R Block, QEII Medical Centre, Nedlands, Western Australia 6009, Australia. Tel: +61893464356; Fax: +61893461665; E-mail: peter.carr@ 123456uwa.edu.au   petercarriv@ 123456gmail.com
                Article
                DOI: 10.1002/ccr3.187
                PMC ID: 4377249
                PubMed ID: 25838907
                SO-VID: 0d481f13-284b-4780-b2b9-117f7bcd8e75
                Copyright © © 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 09 February 2014
                Date revision received : 25 September 2014
                Date accepted : 25 October 2014
                Categories
                Subject: Case Reports

                Data availability:

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