Central venous catheter-related thrombosis is one of the most common and damaging major complications of central venous catheterization, as well as the most common noninfectious complication. The overall span of its incidence is relatively large, about 2% to 67%. There are many causes and risk factors for catheter-related thrombosis, which involve almost all aspects of disease diagnosis and treatment, and these factors are also the main countermeasures to prevent thrombosis. At present, it mainly includes several aspects, such as catheter-related factors, patient-related factors, and treatment-related factors.
Catheter-related factors, mainly including the number of operations at the time of catheterization, the location of the catheter indwelling (simple statistical incidence, femoral vein > jugular vein> subclavian vein), the ratio of the diameter of the catheter to the diameter of the vein increases, the type of catheter (PICC>CVC>IVAP), the infection of the catheter, the improper position of the catheter, the number of lumen of the catheter and the size of the catheter (6F three-lumen tube>5F double-lumen tube>4F single-lumen tube), the material of the catheter (polyethylene, polyvinyl chloride> silicone, polyurethane), Previous indwelling status and number of catheters.
Patient-related factors, including patients with malignant tumor diseases, lesions (patients with metastatic states> lesions are focal patients), recent trauma history or a history of surgery within 30 days, history of venous thrombosis, end-stage renal disease, critically ill patients, systemic infection, catheter relationship infection, advanced age patients, bed rest or braking history within 30 days, hereditary thrombophilia.
Factors associated with treatment include patients with antitumor therapy, history of chest radiation therapy, history of chemotherapy drug bolus, use of anti-angiogenic drugs, use of platinum drugs, use of erythrocyte irritants, parenteral nutrition, and history of surgery.
In response to the above major factors of catheter-related thrombosis, many institutions clinically recommend the implementation of preventive anticoagulation measures, but this is still controversial to reduce the incidence of catheter-related thrombosis, and further observation is needed, therefore, the implementation of routine prophylactic anticoagulation is not recommended. For preventive measures, more positive measures should be aimed at the risk factors they form, so that they can truly achieve targeted goals. In addition, the use of routine prophylactic anticoagulation measures is not recommended except for standardized catheter maintenance measures such as 0.9% sodium chloride solution-heparin flushing tubes.
Perhaps it is precisely because of the higher incidence of catheter-associated thrombosis that the harm is greater. During catheterization, the risk of catheter-associated thrombosis needs to be well assessed. In most cases, the occurrence of thrombosis is asymptomatic, and only 1% to 5% of patients clinically can be accompanied by obvious signs and symptoms. Possible catheter-associated thrombosis can be initially determined by ultrasonography combined with D-dimer testing, and intravenous contrast is the gold standard for diagnosis. The treatment of catheter-associated thrombosis is mainly based on deep vein thrombosis and pulmonary thromboembolism.
Anticoagulation is the treatment of choice after anticoagulation contraindications have been ruled out. Anticoagulation therapy during the retention of the catheter requires continuous and persistent use, and even if the catheter needs to be removed, continuous anticoagulation is still required for 3 to 7 days after the catheter is removed. At the same time, it should be fully evaluated by a specialist according to factors such as the location, size, risk of embolism, and other complications of the thrombus.
Routine removal of catheters that have already developed thrombosis is not recommended in the various current guidelines. For patients with a need for catheter use, it is possible to continue to retain and use normally on the basis of aggressive anticoagulation. For extubation, the currently recognized indications mainly include that the catheter is no longer needed, the catheter has lost its function, the catheter position is abnormal, and the occurrence of catheter-associated infection is combined.
Vena cava filters are an effective means of intercepting blood clots and preventing embolism. Clinically, inferior vena cava filters may be considered in patients with thrombosis with absolute contraindications to anticoagulation and in patients with acute proximal lower extremity catheter-associated thrombosis. For upper extremity catheter-related thrombosis, due to its relatively low incidence and incomplete instrument indications, the implementation of the superior vena cava filter still needs to be comprehensively evaluated and implemented by specialists.