Epidemiology and prevention of catheter-related thrombosis in patients with cancer.
Central venous catheters are extensively used in patients with cancer to secure delivery of chemotherapy and facilitate phlebotomy. Unfortunately, considerable morbidity can result from early complications or late sequelae, ranging from arterial puncture, pneumothorax and bloodstream infections to catheter-related thrombosis (CRT). Contemporary studies have shown that the incidence of symptomatic CRT is ∼5%, whereas the incidence of asymptomatic CRT is higher, at 14-18%. The significance and mechanisms of catheter design, material, insertion location and technique, position of the catheter tip and other risk factors in contributing to the development of CRT are not well understood. Efforts to reduce thrombotic complications, involving flushing the catheter with heparinized solutions, the use of heparin-bonded catheters, and systemic anticoagulant prophylaxis, have been largely ineffective. More studies are needed to understand the pathophysiology of thrombotic complications, to help identify effective interventions to reduce this adverse outcome.
Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, Canada. alee14@bccancer.bc.ca
A Y Y
AY
Lee
P W
PW
Kamphuisen
D000925:Anticoagulants / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy*; D018962:Phlebotomy; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*
D000925:Anticoagulants; D000970:Antineoplastic Agents; D020099:Coated Materials, Biocompatible