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. 1986 Aug;145(2):200–203.

Catheter-Related Septic Central Venous Thrombosis—Current Therapeutic Options

Jeffrey Kaufman 1,2, Christopher Demas 1,2, Karl Stark 1,2, Louis Flancbaum 1,2
PMCID: PMC1306875  PMID: 3765599

Abstract

Central venous catheter-related infection and evidence for central venous thrombosis developed in five patients. On the basis of ongoing bacteremia after catheter removal and venographic confirmation, catheter-related septic central venous thrombosis (CR-SCVT) was confirmed. These patients were treated successfully with anticoagulation and antibiotics; none required surgical exploration or drainage.

CR-SCVT is a complication of modern venous access techniques and is easily confused with sepsis from other anatomic sites. Even when recognized antemortem, CR-SCVT carries an excessive morbidity and mortality. The therapy for this complication is not standardized, but catheter removal, anticoagulation and a prolonged course of antibiotics are appropriate initial therapy. Surgical vein ligation or excision are reserved for refractory sepsis or abscess formation.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahmed N. Thrombosis after central venous cannulation. Med J Aust. 1976 Feb 21;1(8):217–220. [PubMed] [Google Scholar]
  2. Baker C. C., Petersen S. R., Sheldon G. F. Septic phlebitis: a neglected disease. Am J Surg. 1979 Jul;138(1):97–103. doi: 10.1016/0002-9610(79)90248-4. [DOI] [PubMed] [Google Scholar]
  3. Brismar B., Hårdstedt C., Jacobson S. Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization. Ann Surg. 1981 Dec;194(6):779–783. doi: 10.1097/00000658-198112000-00021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brismar B., Malmborg A. S. Prophylaxis against microbial colonization of venous catheters. J Hosp Infect. 1981 Mar;2(1):37–43. doi: 10.1016/0195-6701(81)90004-9. [DOI] [PubMed] [Google Scholar]
  5. CRANE C. Venous interruption for septic thrombophlebitis. N Engl J Med. 1960 May 12;262:947–951. doi: 10.1056/NEJM196005122621901. [DOI] [PubMed] [Google Scholar]
  6. Davis D., Petersen J., Feldman R., Cho C., Stevick C. A. Subclavian venous stenosis. A complication of subclavian dialysis. JAMA. 1984 Dec 28;252(24):3404–3406. doi: 10.1001/jama.252.24.3404. [DOI] [PubMed] [Google Scholar]
  7. Dorner D. B., Stubbs D. H., Shadur C. A., Flynn C. T. Percutaneous subclavian vein catheter hemodialysis--impact on vascular access surgery. Surgery. 1982 Jun;91(6):712–715. [PubMed] [Google Scholar]
  8. Fallon W. F., Jr, Golocovsky M., Paul B. K., Champion H. R. Suppurative mediastinitis as a complication of long-term total parenteral nutrition therapy via subclavian vein. Crit Care Med. 1981 Jul;9(7):558–559. doi: 10.1097/00003246-198107000-00012. [DOI] [PubMed] [Google Scholar]
  9. Fishman E. K., Pakter R. L., Gayler B. W., Wheeler P. S., Siegelman S. S. Jugular venous thrombosis: diagnosis by computed tomography. J Comput Assist Tomogr. 1984 Oct;8(5):963–968. doi: 10.1097/00004728-198410000-00030. [DOI] [PubMed] [Google Scholar]
  10. Harley D. P., White R. A., Nelson R. J., Mehringer C. M. Pulmonary embolism secondary to venous thrombosis of the arm. Am J Surg. 1984 Feb;147(2):221–224. doi: 10.1016/0002-9610(84)90093-x. [DOI] [PubMed] [Google Scholar]
  11. Henzel J. H., DeWeese M. S. Morbid and mortal complications associated with prolonged central venous cannulation. Awareness, recognition, and prevention. Am J Surg. 1971 May;121(5):600–605. doi: 10.1016/0002-9610(71)90149-8. [DOI] [PubMed] [Google Scholar]
  12. Hoar P. F., Wilson R. M., Mangano D. T., Avery G. J., 2nd, Szarnicki R. J., Hill J. D. Heparin bonding reduces thrombogenicity of pulmonary-artery catheters. N Engl J Med. 1981 Oct 22;305(17):993–995. doi: 10.1056/NEJM198110223051707. [DOI] [PubMed] [Google Scholar]
  13. Jacobs M. B., Yeager M. Thrombotic and infectious complications of Hickman-Broviac catheters. Arch Intern Med. 1984 Aug;144(8):1597–1599. [PubMed] [Google Scholar]
  14. McMichan J. C., Michel L. Guide wire-sheath technique for pulmonary artery catheterization and central vein cannulation. Intensive Care Med. 1979 Mar;5(1):37–39. doi: 10.1007/BF01739001. [DOI] [PubMed] [Google Scholar]
  15. Mitre R. J., Rotheran E. B., Jr Anaerobic septicemia from thrombophlebitis of the internal jugular vein. Successful treatment with metronidazole. JAMA. 1974 Nov 25;230(8):1168–1169. [PubMed] [Google Scholar]
  16. O'Neill J. A., Jr, Pruitt B. A., Jr, Foley F. D., Moncrief J. A. Suppurative thrombophlebitis--a lethal complication of intravenous therapy. J Trauma. 1968 Mar;8(2):256–267. doi: 10.1097/00005373-196803000-00012. [DOI] [PubMed] [Google Scholar]
  17. Patel S., Brennan J. Diagnosis of internal jugular vein thrombosis by computed tomography. J Comput Assist Tomogr. 1981 Apr;5(2):197–200. doi: 10.1097/00004728-198104000-00010. [DOI] [PubMed] [Google Scholar]
  18. Powell D. C., Bivins B. A., Bell R. M., Sachatello C. R., Griffen W. O., Jr Bacterial endocarditis in the critically ill surgical patient. Arch Surg. 1981 Mar;116(3):311–314. doi: 10.1001/archsurg.1981.01380150039010. [DOI] [PubMed] [Google Scholar]
  19. Press O. W., Ramsey P. G., Larson E. B., Fefer A., Hickman R. O. Hickman catheter infections in patients with malignancies. Medicine (Baltimore) 1984 Jul;63(4):189–200. doi: 10.1097/00005792-198407000-00001. [DOI] [PubMed] [Google Scholar]
  20. Ratcliffe F. M. Suppurative thrombosis of the superior vena cava: a lethal complication of central venous catheters. Intensive Care Med. 1985;11(5):265–266. doi: 10.1007/BF00260362. [DOI] [PubMed] [Google Scholar]
  21. Ryan J. A., Jr, Abel R. M., Abbott W. M., Hopkins C. C., Chesney T. M., Colley R., Phillips K., Fischer J. E. Catheter complications in total parenteral nutrition. A prospective study of 200 consecutive patients. N Engl J Med. 1974 Apr 4;290(14):757–761. doi: 10.1056/NEJM197404042901401. [DOI] [PubMed] [Google Scholar]
  22. Sanders R. A., Sheldon G. F. Septic complications of total parenteral nutrition. A five year experience. Am J Surg. 1976 Aug;132(2):214–220. doi: 10.1016/0002-9610(76)90050-7. [DOI] [PubMed] [Google Scholar]
  23. Schwarzbeck A., Brittinger W. D., Henning G. E., Strauch M. Cannulation of subclavian vein for hemodialysis using Seldinger's technique. Trans Am Soc Artif Intern Organs. 1978;24:27–31. [PubMed] [Google Scholar]
  24. Stein J. M., Pruitt B. A., Jr Suppurative thrombophlebitis. A lethal iatrogenic disease. N Engl J Med. 1970 Jun 25;282(26):1452–1455. doi: 10.1056/NEJM197006252822603. [DOI] [PubMed] [Google Scholar]
  25. Stillman R. M., Soliman F., Garcia L., Sawyer P. N. Etiology of catheter-associated sepsis. Correlation with thrombogenicity. Arch Surg. 1977 Dec;112(12):1497–1499. doi: 10.1001/archsurg.1977.01370120087011. [DOI] [PubMed] [Google Scholar]
  26. Strinden W. D., Helgerson R. B., Maki D. G. Candida septic thrombosis of the great central veins associated with central catheters. Clinical features and management. Ann Surg. 1985 Nov;202(5):653–658. doi: 10.1097/00000658-198511000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Vic-Dupont, Cormier J. M., Lecompte Y. La ligature veineuse dans les thrombophlébites suppurées secondaires aux cathétérismes veineux. Chirurgie. 1973 Mar 21;99(5):285–292. [PubMed] [Google Scholar]
  28. Wagman L. D., Kirkemo A., Johnston M. R. Venous access: a prospective, randomized study of the Hickman catheter. Surgery. 1984 Mar;95(3):303–308. [PubMed] [Google Scholar]
  29. Warden G. D., Wilmore D. W., Pruitt B. A., Jr Central venous thrombosis: a hazard of medical progress. J Trauma. 1973 Jul;13(7):620–626. [PubMed] [Google Scholar]
  30. Winn R. E., Tuttle K. L., Gilbert D. N. Surgical approach to extensive suppurative thrombophlebitis of the central veins of the chest. J Thorac Cardiovasc Surg. 1981 Apr;81(4):564–568. [PubMed] [Google Scholar]

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