Central catheter-related venous thrombosis

Central catheter-related venous thrombosis is a common cause of upper limb DVT, particularly in patients with underlying malignancy.

Note: “Catheter” here refers to central lines such as PICC, portacath, and similar devices, not peripheral IV cannulae.

Routine anticoagulation is recommended in all cases of catheter-related DVT.

Routine prophylaxis is not recommended in patients with catheters.

Management depends on whether the catheter is still required and whether the patient has underlying malignant disease.

Pathophysiology
  • Catheter-related venous thrombosis is a common cause of upper limb DVT, particularly in patients with underlying malignancy
  • Central venous catheters can lead to thrombosis directly through mechanical and endothelial disruption.
  • In malignancy, a hypercoagulable state may contribute significantly to thrombosis risk.
  • A new thrombosis may also signify progression of underlying cancer.
Clinical Assessment
  • In patients with malignancy, assess for:
    • Catheter function and positioning
    • Underlying cancer progression
    • Pulmonary embolism
    • Associated infection or sepsis
Investigations
  • Bloods:
    1. FBE
    2. U&Es / glucose
    3. Others as clinically indicated
    4. Thrombophilia screen not routinely required unless additional risk factors
    5. Microbiological studies on removed catheter if infection suspected
  • Imaging:
    • Plain radiograph: to confirm catheter positioning
Management
General Principles
  • All cases: commence therapeutic anticoagulation (typically LMWH initially)
Catheter No Longer Required
  • Remove catheter
  • Commence LMWHThen:
    • If no active malignancy: switch to warfarin or NOAC, treat for 3 months post-removal
    • If active malignancy: continue LMWH for 3 months post-removal
Catheter Still Required
  • Ensure catheter is functional and well-positioned
  • Continue LMWHThen:
    • If no malignancy: switch to warfarin or NOAC for 3 months
    • If active malignancy: continue LMWH until catheter no longer needed, then treat for 3 months after removal
Catheter Dysfunction or Malposition
  • Remove and replace catheter
Additional Notes
  • Indefinite anticoagulation is not generally indicated unless recurrent thrombosis occurs
  • IVC filter and catheter-directed thrombolysis are not routinely recommended
Disposition
  • Follow-up required by General Medicine, Oncology, or Clinical Haematology
  • A clear plan for anticoagulation duration must be documented

Haematology follow-up is particularly recommended if:

  • Duration of anticoagulation is unclear
  • Bleeding risk is elevated
  • NOAC use is planned
  • Clinical concerns arise

At follow-up:

  • Repeat Doppler US of affected limb:
    • Residual clot is common
    • Does not typically alter treatment duration unless extensive or worsening
Future Management
  • DVT prophylaxis is recommended for all future inpatient stays
  • Routine prophylaxis is not required for new catheters in those with previous catheter-related DVT
  • Consider therapeutic anticoagulation in high-risk cases

References

Publications

FOAMed

Fellowship Notes

Physician in training. German translator and lover of medical history.

Dr James Hayes LITFL author

Educator, magister, munus exemplar, dicata in agro subitis medicina et discrimine cura | FFS |

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