Catheter-related thrombosis: A practical approach

Abstract

Catheter-related thrombosis is a relatively common complication of central venous catheter insertion. Central venous catheter use is ubiquitous in the critical care setting and often in patients with multiple risk factors for venous thromboembolism. With a trend towards increased use of peripherally inserted central catheters, the incidence of catheter-related thrombosis is likely to increase further. Despite the scale of the problem, there is a paucity of evidence-based guidelines concerning the management of patients with catheter-related thrombosis, particularly in critically unwell patients. This has led to heterogeneity in clinical practice. In this review, we describe the risk factors for developing catheter-related thrombosis and provide practical advice for clinicians on how to recognise, diagnose and treat this common problem.

Keywords: Catheter-related thrombosis; anticoagulation; central venous catheter; peripherally inserted central catheter; venous thromboembolism.

Figures

Figure 1.

Postulated mechanisms by which the presence of a CVC may contribute to the development of thrombosis.

Figure 2.

Schematic image of thrombotic events that may be associated with central venous catheters.

Figure 3.

Proposed treatment algorithm for patients with confirmed CRT. CVC: central venous catheter; LMWH: low-molecular weight heparin.