Academic literature on the topic 'Central venous thrombosis'
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Journal articles on the topic "Central venous thrombosis"
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Demey, Hendrik E., Guy Lambrecht, Greta Moorkens, Peter Michielsen, Jef Van Den Ende, and Leo L. Bossaert. "Thrombolysis in Central Splanchnic Thrombosis." Journal of Intensive Care Medicine 12, no. 5 (1997): 269–75. http://dx.doi.org/10.1177/088506669701200508.
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We present 4 patients treated with streptokinase for different forms of abdominal venous thrombosis. Two patients suffered from central splanchnic venous thrombosis (superior mesenteric vein and bilateral iliac veins in Patient A, portal and superior mesenteric veins in Patient B). Both patients' presenting complaint was abdominal pain. In both, a temporary infection-associated circulating lupus anticoagulant presumably caused this condition. Two other patients presented with isolated portal vein thrombosis without lupus anticoagulant. Thrombolysis with high dose streptokinase (9 MU over 6 hours) successfully reopened the veins involved in all 4 patients. A literature survey showed that thrombolysis is a therapeutic option for mesenteric vein thrombosis, but there was no consensus on which thrombolytic drug should be given or on method of administration.
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Wever, M. L. G., K. D. Liem, W. B. Geven, and R. B. Tanke. "Urokinase Therapy in Neonates with Catheter Related Central Venous Thrombosis." Thrombosis and Haemostasis 73, no. 02 (1995): 180–85. http://dx.doi.org/10.1055/s-0038-1653748.
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SummaryThe results of fibrinolytic therapy with urokinase were evaluated in 26 neonates with catheter related central venous thrombosis. Complete thrombolysis could be achieved in 13 patients (50%), partial thrombolysis in 3 patients (12%). No effect was seen in 10 patients (38%). Therapy success was influenced by age, size and location of the thrombus. Coincidence of infection occurred in 16 patients (62%). Mild hemorrhagic complications were seen in 2 patients (8%), no other significant side effects were observed. Nine patients with residual thrombosis were treated with oral anticoagulants following urokinase resulting in resolution of the thrombus in 6 patients within 3 months (67%). The incidence of asymptomatic recurrent thrombosis was high (28%). Urokinase might be an effective and safe treatment for central venous thrombosis in neonates. Prophylactic antibiotic therapy during the infusion of urokinase and long-term treatment with oral anticoagulants after thrombosis are advisable. Early detection of thrombosis might enhance the success rate of fibrinolytic therapy. Therefore, we strongly recommend routine echocardiographic screening of central venous catheters.
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Gollin, Gerald, Barbara Ward, George H. Meier, Bauer E. Sumpio, and Richard J. Gusberg. "Central Splanchnic Venous Thrombosis." Journal of Clinical Gastroenterology 18, no. 2 (1994): 109–13. http://dx.doi.org/10.1097/00004836-199403000-00005.
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Borges, Cláudia, António Antunes, Catarina Pereira, et al. "P0401 CENTRAL VENOUS THROMBOSIS." European Journal of Internal Medicine 20 (May 2009): S136. http://dx.doi.org/10.1016/s0953-6205(09)60421-0.
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TOROSIAN, MICHAEL H., STEVEN MERANZE, JAMES L. MULLEN, and GORDON MCLEAN. "Central Venous Access with Occlusive Superior Central Venous Thrombosis." Annals of Surgery 203, no. 1 (1986): 30–33. http://dx.doi.org/10.1097/00000658-198601000-00006.
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Geerts, William. "Central venous catheter–related thrombosis." Hematology 2014, no. 1 (2014): 306–11. http://dx.doi.org/10.1182/asheducation-2014.1.306.
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Abstract Thrombotic complications associated with the use of central venous catheters (CVCs) are common and lead to distressing patient symptoms, catheter dysfunction, increased risk of infections, long-term central venous stenosis, and considerable costs of care. Risk factors for catheter-related thrombosis include use of larger, multilumen, and peripherally inserted catheters in patients with cancer receiving chemotherapy. Symptomatic catheter-related thrombosis is treated with anticoagulation, generally without removing the catheter. The intensity and duration of anticoagulation depend on the extent of thrombosis, risk of bleeding, and need for continued use of a CVC. To date, the clinical benefit of prophylactic doses of anticoagulant has been disappointing and these agents are not used routinely for this purpose. This chapter focuses on recent evidence, remaining controversies, and practical approaches to reducing the burden of thrombosis associated with CVCs.
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Obeso, Andrés, Laura Romero Vázquez, and Jorge Fernández Noya. "Chylothorax and Central Venous Thrombosis." JACC: Case Reports 3, no. 14 (2021): 1576–78. http://dx.doi.org/10.1016/j.jaccas.2021.07.026.
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Lowell, Jeffrey A., and Albert Bothe. "Central Venous Catheter Related Thrombosis." Surgical Oncology Clinics of North America 4, no. 3 (1995): 479–92. http://dx.doi.org/10.1016/s1055-3207(18)30439-3.
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Park, Christina K., Bosco A. Paes, Kim Nagel, Anthony K. Chan, and Prashanth Murthy. "Neonatal central venous catheter thrombosis." Blood Coagulation & Fibrinolysis 25, no. 2 (2014): 97–106. http://dx.doi.org/10.1097/mbc.0b013e328364f9b0.
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Yacopetti, Nicholas. "Central Venous Catheter-Related Thrombosis." Journal of Infusion Nursing 31, no. 4 (2008): 241–48. http://dx.doi.org/10.1097/01.nan.0000326833.59655.9e.
Full textDissertations / Theses on the topic "Central venous thrombosis"
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Ikesaka, Rick. "The Risk of Upper Extremity Deep Vein Thrombosis and Primary Thromboprophylaxis with Low Dose Rivaroxaban in Oncology Patients with Central Venous Catheters." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/41954.
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Venous thromboembolism (VTE) is a common disorder which causes significant morbidity and mortality. Upper extremity deep vein thrombosis(UEDVT) is a relatively understudied subtype of VTE which is commonly associated with central venous catheters, cancer, and thrombophilia.
The goal of this project was to better characterize the risk of UEDVT and to design and execute a pilot study that will demonstrate the efficacy of a strategy preventing the occurrence of VTE in a high-risk population for UEDVT.
This M.Sc project, was conducted in three parts.
Chapter 1 of the thesis outlines a systematic review of the literature which assessed the risk of VTE in UEDVT patients by search for and including data from studies with patients with prospectively enrolled symptomatic UEDVT.
Chapter 2 describes the development and final protocol of the TRIM-Line pilot study, a randomized open-label study comparing 90 days of rivaroxaban 10mg po daily against the current standard of care (observation) in patients with active cancer and central venous catheters, two known risk factors for VTE.
Finally in Chapter 3 the TRIM-Line study was executed as a pilot trial involving The Ottawa Hospital and the Juravinski Cancer Centre located in Hamilton. The study was conducted from March 2019 until February 2020. 105 patients underwent randomization at the two Canadian centres. The study met its prespecified feasibility endpoint average enrolment rate of 7.5 per month (95% CI:4.56, 10.44) at the coordinating Ottawa Hospital site and 2.0 per month (95% CI:0.87, 3.13) for the Juravinski Cancer Centre site. The randomized controlled trial met its enrollment targets and demonstrated that a full scale randomized controlled trial on the topic of prevention of cancer associated venous thromboembolism is feasible.
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Karevaara, Anette. "Komplikationer hos patienter med PICC." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-213215.
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SAMMANFATTNING Bakgrund: PICC är en central infart som används inom vården för att kunna ge kärlretande läkemedel. Komplikationer vid användning av PICC kan vara infektion, trombos, tromboflebit eller stopp i katetern. Syfte: Syftet med studien är att undersöka förekomsten av komplikationer av PICC hos onkologiska patienter samt för att se om det finns några skillnader mellan olika diagnosgrupper och behandlingar med avseende på förekomsten av djupa ventromboser (DVT) och infektioner. Syftet är också att ta reda på hur länge en PICC sitter och hur vanligt det är att en PICC felplaceras. Metod: Metoden som används är en retrospektiv, deskriptiv, kvantitativ undersökning. I studien ingår alla onkologpatienter som fått en PICC år 2009-2011 (n=677). Data samlades in med hjälp av journalgranskning. Resultat: Förekomsten av DVT var 5,6 %. Patienter som fick behandling med Capecitabin hade statistiskt signifikant mer DVT jämfört med andra behandlingar. Patienter som fick behandling med R-CHOP hade statistiskt signifikant mindre DVT jämfört med andra behandlingar. Antalet infektioner var 3 %. Stopp i katetern drabbade 1,8 % av patienterna, 17 % hade besvär med rodnad under förbandet, 12 % av alla katetrar åkte ut 4 cm eller mer och 2,5 % av katetrarna felplacerades vid inläggningen. En PICC var insatt i medelvärde 92 dagar, median 105 dagar. Slutsats: Förekomsten av komplikationer av PICC var låg hos onkologiska patienter med undantag för hudbesvär som förekom hos var sjätte patient. Behandlingar innehållande Capecitabin förefaller öka risken för DVT men fler studier behövs för att öka kunskaperna om detta. PICC är en säker venös infart vid behandling med cytostatika.<br>ABSTRACT Background: PICC (peripherally inserted central catheter) is a central line used in healthcare to provide vascular irritant drugs. Complications with PICC can be infection, thrombosis, thrombophlebitis or occlusion of the catheter. Aim: The aim of the study is to examine the incidence of complications of PICC in oncology patients and to see if there are any differences between diagnostic groups and treatments for the presence of deep venous thrombosis (DVT) and infection. The aim is also to find out for how long time a PICC is inserted and how common it is for a PICC misplaced. Method: The method used is a retrospective, descriptive, quantitative survey. The study includes all oncology patients who received a PICC years 2009-2011 (n=677). Data were collected through medical record review. Results: The incidence of DVT was 5,6 %. Patients treated with Capecitabin had statistically significantly more DVT compared with other treatments. Patients treated with R-CHOP had statistically significantly less DVT compared with other treatments. The incidence of infections was 3 %. Occlusion of the catheter affected 1,8 % of patients, 17 % had problems with redness under the dressing, 12 % of all catheters went out four cm or more and 2,5 % of the catheters were misplaced at insertion. A PICC was inserted in mean 92 days, median 105 days. Conclusion: The complication rate of PICC was low in oncology patients with the exception of skin problems that occurred in every sixth patient. Treatments containing Capecitabin appears to increase the risk of DVT but more studies are needed to raise awareness of this. PICC is a safe venous access for chemotherapy.
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Pereira, Mora José Mauricio [Verfasser]. "Central venous catheter induced thrombosis in dogs : occurrence under an antithrombotic treatment regimen and possible indicators / José Mauricio Pereira Mora." Hannover : Stiftung Tierärztliche Hochschule Hannover, 2020. http://d-nb.info/1225740339/34.
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Arone, Katia Michelli Bertoldi. "Obstrução trombótica do cateter venoso central no transplante de células-tronco hematopoéticas." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-16052011-161505/.
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Os pacientes submetidos ao transplante de células-tronco hematopoéticas (TCTH) necessitam da inserção do cateter venoso central (CVC) de longa permanência e semi-implantado. No entanto, a obstrução trombótica do CVC é uma complicação que pode ocasionar o funcionamento inadequado do dispositivo intravascular e levar sua remoção precoce. Este estudo trata-se de uma revisão integrativa da literatura, com o objetivo de sintetizar as medidas relacionadas à prevenção e tratamento da obstrução trombótica relacionada ao CVC de longa permanência e semi-implantado, nos pacientes submetidos ao TCTH. A amostra constituiu-se de sete estudos primários, sendo dois ensaios clínicos randomizados, três estudos de coorte e duas séries de casos. Quanto as categorias temáticas, quatro estudos abordaram medidas de prevenção da obstrução trombótica relacionada ao CVC, dois estudos abordaram as medidas de tratamento e um abordou as medidas de prevenção e tratamento. Dentre os estudos que abordaram medidas de prevenção, obteve-se um único que se mostrou efetivo na prevenção da obstrução, trata-se de um coorte sobre o uso da varfarina oral, iniciado no dia da inserção do dispositivo venoso central. Os demais estudos não evidenciaram diferenças estatisticamente significantes entre o tratamento padrão e a intervenção testada. Quanto às medidas de tratamento, três estudos evidenciaram sucesso, sendo que um apontou a eficácia do uso de estreptoquinase ou uroquinase, outro estudo mostrou benefício no uso de heparina de baixo peso molecular e outro tratou a obstrução com heparina e uroquinase com sucesso. Nota-se que a evolução da pesquisa referente a perviedade do CVC foi restrita, não acompanhando a evolução da terapia com CTH, principalmente, no que tange os cuidados de enfermagem, visto que todos tratam de intervenções medicamentosas, sem abordar os aspectos não medicamentosos, como, por exemplo, volume e freqüência do flush com solução fisiológica, descrição da técnica com pressão positiva, tamanho ideal da seringa, pressão exercida durante a infusão de medicamentos e dispositivos para vedação dos lumens do cateter com pressão positiva. Tais resultados mostram a necessidade da realização de novos estudos controlados, para testar as intervenções de enfermagem na prevenção da obstrução trombótica relacionada ao cateter.<br>Patients submitted to hematopoietic stem cell transplantation (HSCT) need indwelling and semi-implanted central venous catheterization. Thrombotic obstruction of CVC, however, is a complication that can lead to the inadequate functioning of the intravascular device and its early removal. This integrative literature review aimed to summarize measures for the prevention and treatment of thrombotic obstruction related to indwelling and semi-implanted CVC, in patients submitted to HSCT. The sample included seven primary studies, with two randomized clinical trials, three cohorts and two case series. As for the theme categories, four studies discussed CVC-related thrombotic obstruction prevention measures, two addressed treatment measures and one prevention and treatment measures. Among the studies that discussed prevention measures, one single research showed effective obstruction prevention, which was a cohort on the use of oral warfarin, started on the day the central venous device was inserted. The other studies showed no statistically significant differences between standard treatment and the tested intervention. Regarding treatment measures, three studies showed to be successful: one appointed the efficacy of streptokinase or urokinase use, another showed the benefits of using low molecular weight heparin and the third successfully treated the obstruction with heparin and urokinase. The restricted evolution of research regarding CVC patency was observed, which did not accompany the evolution of HSC therapy, mainly regarding nursing care, as all addressed discuss medication interventions, without discussing non-medication aspects, such as the flush volume and frequency with physiological salt solution, description of positive pressure technique, ideal syringe size, pressure exerted during medication infusion and catheter lumen sealing devices with positive pressure. These results show the need for further controlled studies to test nursing interventions in the prevention of catheter-related thrombotic obstruction.
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Silva, Eunice Vieira Cavalcante. "Uso de cateter central de inserção periférica para redução da incidência de flebite relacionada a acesso venoso durante a infusão de inotrópico em pacientes com insuficiência cardíaca descompensada: ensaio clínico randomizado." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-06022017-113724/.
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Fundamento: Na descompensação da insuficiência cardíaca, pode ocorrer o baixo débito cardíaco, nessa situação o uso de inotrópico pode ser necessário. Se o acesso venoso for periférico, a infusão venosa prolongada de inotrópicos pode levar à flebite. Por outro lado, o acesso venoso central pode apresentar complicações. O Cateter Central de Inserção Periférica (PICC) pode ser uma opção nessa situação. O objetivo do presente estudo foi avaliar a incidência de flebite com o uso do PICC em comparação ao acesso venoso periférico. Métodos: em estudo clínico randomizado foram selecionados pacientes com insuficiência cardíaca congestiva avançada, em uso de inotrópico endovenoso; plaquetas >= 50.000/mm3 e fração de ejeção do ventrículo esquerdo (FEVE) < 0,45. Os pacientes foram randomizados para receberem o PICC ou manter o acesso venoso periférico. O desfecho principal foi à ocorrência de flebite. Os dados foram analisados pela regressão logística. Resultados: Foram incluídos 40 pacientes no Grupo PICC e 40 pacientes no grupo controle. A mediana da idade foi de 61,5 (IQR=16) anos, a FEVE foi de 24,0 (IQR= 10) % e a dose da dobutamina foi de 7,73 (IQR = 5,3) mcg/kg*min. No Grupo PICC a ocorrência de flebite foi de 2,5 % (1 paciente) enquanto no grupo controle foi de 95% (38 pacientes), com razão dos riscos (HR) de 0,1% (IC 95%: 0,0 a 1,6%, P < 0,001). Conclusões: O uso de PICC foi associado a redução da incidência de flebite durante a infusão endovenosa contínua de dobutamina em pacientes com baixo débito cardíaco durante internação por insuficiência cardíaca descompensada<br>Background: During decompensated heart failure, the use of intravenous inotropes can be necessary. With peripheral venous access, prolonged infusions can cause phlebitis. However, traditional central venous catheters have possible complications. Peripherally inserted central catheters (PICCs) may be an alternative to traditional catheters. Our objective was to compare the incidence of phlebitis between PICCs and catheters used to achieve peripheral venous access. Methods: In a randomized clinical trial, 40 patients were randomized to the PICC group and 40 patients were randomized to thecontrol group. The inclusion criteria were advanced heart failure, ejection fraction < 0.45, and platelets > 50,000/mm3. The patients were randomly assigned to receivea PICC or keep their peripheral venous access. The primary endpoint was the occurrence of phlebitis. Results: We included 40 patients in the PICC group and 40 patients in the control group. The median age was 61.5 (interquartile range [IQR]=16) years, the ejection fraction was 0.24 (IQR=0.10), and the dobutamine dose was 7.73 (IQR=5.3) mcg/kg*min. Phlebitis occurred in 1 patient (2.5%) in the PICC group and in 38 patients (95.0%) in the control group, with a hazard ratio of 0.1% (95% confidence interval [CI]: 0.0%-1.6%, P < 0.001). Conclusion: PICCs were associated with a lower incidence of phlebitis in patients hospitalized for decompensated heart failure with low cardiac output during intravenous dobutamine infusions
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Mer, Mervyn. "Central venous catheter-related infection." Thesis, 2014.
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Introduction and Background: Central venous catheters (CVCs) are extensively used worldwide. Mechanical, infectious and thrombotic complications are well described with their use and may be associated with prolonged hospitalisation, increased medical costs and mortality.
CVCs account for an estimated 90% of all catheter-related bloodstream infections (CRBSI) and a host of risk factors for CVC-related infections have been documented. These include, most importantly, the duration of catheterisation. The duration of use of CVCs remains controversial and the length of time such devices can safely be left in place has not been fully and objectively addressed in the critically ill patient. Over the past few years, antimicrobial impregnated catheters have been introduced in an attempt to limit catheter-related infection (CRI) and increase the time that CVCs can safely be left in situ. Recent meta-analyses concluded that antimicrobial-impregnated CVCs appear to be effective in reducing CRI.
Materials and Methods: This was a prospective randomised double-blind study performed in the adult multidisciplinary Intensive Care Unit (ICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) over a four year period. The study entailed a comparison of standard triple-lumen versus antimicrobial impregnated CVCs on the rate of CRI. The aim was to determine whether the duration of catheter insertion time could safely be increased from the standard practice of seven days at the CMJAH adult multidisciplinary ICU to 14 days, to assess the influence of the antimicrobial impregnated catheter on the incidence of CRI, and to elucidate the epidemiology and risks of CRI.
Results: One hundred and eighteen critically ill patients were included in the study which spanned 34 951.5 catheter hours (3.99 catheter years). Sixty-two patients received a standard triple-lumen catheter and 56, a chlorhexidine-silver sulfadiazine (CSS) impregnated triple-lumen catheter. The mean duration of placement for the full sample of
118 CVCs was 12.3 days (range, 1-14). No statistically significant difference in CRI rates between the two types of catheters could be demonstrated. The most common source of primary CRBSI was skin, followed by hub and infusate. The site of CVC insertion (internal jugular versus subclavian vein) and the use of parenteral nutrition were not noted to be risk factors for catheter infection. There was no clinical evidence of catheter-related thrombosis in either of the study groups.
Conclusion: This study was unable to demonstrate that antimicrobial catheters provided any significant benefit over standard catheters, which it is felt, can safely be left in place for up to 14 days with appropriate infection control measures. The most common source of CRI was the skin. The administration of parenteral nutrition and the site of catheter insertion (internal jugular vein versus subclavian vein) were not noted to be risk factors for CRI. There was no clinical evidence of thrombotic complications in either of the study groups. This study offers direction for the use of CVCs in critically ill patients and addresses many of the controversies that exist.
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Nguyen, Doan-Trang. "Étude de prévention de la thrombose veineuse associée au cathéter veineux central de type PICC chez les patients en oncologie recevant une chimiothérapie." Thèse, 2008. http://hdl.handle.net/1866/2777.
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Nous avons mené une étude prospective randomisée dans le but de comparer l'effet de l'irrigation du cathéter de type PICC avec deux types d'anticoagulants: Héparine standard et Tinzaparine, une héparine de faible poids moléculaire. Notre étude s'adresse aux patients de la clinique externe d'oncologie de l'hôpital Maisonneuve-Rosemont. Entre début Mai 2005 et Mars 2008, nous avons recruté 131 patients dont 70 ont été randomisés. Parmi les 61 patients exclus, 23 n'ont pas rencontré les critères d'inclusion, 30 ont refusé de participer et 8 ne sont pas inclus pour d'autres raisons. Sur les 70, 36 sujets sont randomisés dans le groupe Héparine standard et 34 dans le groupe Tinzaparine. La population en intention de traiter comprend 65 sujets dont 32 dans le groupe Héparine standard et 33 dans le groupe Tinzaparine. Le médicament a été administré pendant un mombre maximal de 30 jours et les sujets ont été suivis pendant 90 jours. La thrombose veineuse associée au cathéter (TVAC) a été objectivée par une phlébographie ou une échographie-Doppler à la fin de la période de 30 jours suivant l'installation du cathéter. L'incidence de la TVAC sur 30 jours est de 14,39 par 1000 cathéter-jours (IC à 95%:[9,0;19,79]/1000 cathéter-jours ou 41,5% (27/65). L'incidence de la thrombose veineuse profonde (TVP) symptômatique du membre supérieur sur la période de suivi de 90 jours est de 0,41 par 1000 cathéter-jours (IC à 95%:[0,08;0,81]/1000 cathéter-jours ou 3% (2/65). Nous n'avons observé aucune différence entre les deux groupes par rapport à la fréquence de la TVAC ni de la TVP. Nous ne pouvons conclure à une différence dans l'efficacité de la Tinzaparine par rapport à l'Héparine standard dans la prévention de la TVAC.<br>Our prospective, randomized study aims at comparing the effectiveness of two types of heparin used for the instillation of peripherally inserted central catheter (PICC): Standard heparin and Tinzaparin, a low molecular weight heparin. We recruited patients from the ambulatory center of Maisonneuve-Rosemont hospital. Between the beginning of May 2005 and March 2008, 131 patients were enrolled. Of 61 patients excluded, 23 did not satisfy the inclusion criteria, 30 refused to participate and 8 were not enrolled for other reasons. Seventy patients were randomized into two groups, 36 in the Standard heparin group and 34 in the Tinzaparin group. Our population intent-to-treat included 65/70 patients, 32 of these received Standard heparin and 33 received Tinzaparin. The experimental intervention was administered for a maximum of 30 days and all the subjects were followed up for 90 days. The events were documented objectively with a venogram or Doppler ultrasonography by the end of the 30 days following the catheter installation. The incidence of catheter-related venous thrombosis (CRVT) during 30 days of instillation is 14,39/1000 catheter-days (CI 95%:[9,0;19,79]/1000 catheter-days or 41.5% (27/65). The incidence of symptomatic upper extremity deep venous thrombosis (DVT) during the observation period of 90 days is 0,41/1000 catheter-days (CI 95%:[0,08;0,81]/1000 catheter-days or 3% (2/65). We did not observe any difference in the frequency of CRVT or DVT between the two groups. We can not conclude that either Standard heparin or Tinzaparin is more effective in the prevention of CRVT in our population.
Books on the topic "Central venous thrombosis"
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Cassidy, Jim, Donald Bissett, Roy A. J. Spence OBE, Miranda Payne, and Gareth Morris-Stiff. Complications of long-term central venous lines and chemotherapy extravasation. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199689842.003.0037.
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Describes the need for central venous access. The types of devices in common use together with their strengths and weaknesses. Describes, symptoms and signs of complications such as thrombosis or infection of lines. Outlines investigation and therapy strategies. Describes problem of extravasation of chemotherapy drugs into peripheral tissues. Outlines immediate therapy guidelines and describes long term consequences of this side effect
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Zahra, Mahmoud, and Ganesh Krishnamurthy. Endovascular Snaring Technique for Shortening of Central Venous Port Catheters in Children. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0042.
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Implanted venous ports in children are commonly placed by pediatric interventional radiologists, primarily through the internal jugular vein to allow long-term delivery of intravenous access. The ideal location of the catheter tip is the junction of the superior vena cava and right atrium. High catheter tip positions may result in failure of the port catheter due to venous thrombosis, catheter occlusion, or fibrin sheath formation, whereas low catheter tip positions may cause catheter occlusion, cardiac arrhythmias, or perforation. This chapter describes indications, contraindications, equipment, techniques, and complications of the endovascular snaring technique of central venous port tip revision in children.
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O’Leary, Ronan, and Andrew R. Bodenham. Arterial and venous cannulation in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0130.
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Despite being almost ubiquitous within the critically- ill population, vascular access remains a frequent cause of iatrogenic injury, manifested as both procedural complications and later events, such as infection and thrombosis. Untoward events are minimized by expert tuition and meticulous practical technique. Consensus guidelines on training in vascular access are discussed. Vascular access, particularly central catheterization, should not be undertaken lightly. Can a patient be managed without vascular access or can the number of vascular access devices be rationalized? Other routes for drug and fluid administration exist, particularly enterally during the recovery phase. This chapter covers vascular access during critical illness and discusses the development of more advanced techniques.
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Patel, Mikin V., and Steven Zangan. Transhepatic Snare Placement for Translumbar Inferior Vena Cava Access. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0044.
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In patients requiring long-term chemotherapy, antibiotics, hemodialysis, or parenteral nutrition, central venous access is usually possible via catheter placement in the jugular, subclavian, or femoral veins. As these routes become complicated by thrombosis, stenosis, infection, or surgical intervention, the options for central venous catheter placement become limited, and direct puncture of the inferior vena cava (IVC) may be required. This chapter reviews the technique for placement of a catheter in the IVC via translumbar approach. Because direct access using anatomic landmarks can be challenging, initial puncture of the hepatic veins can be used to guide placement of an IVC catheter.
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McIntyre, Rebecca. Hemophilia. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0034.
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Patients with hemophilia can be safely managed for elective surgery such as adenotonsillectomy as long as adequate planning and consultation with the hematology department occurs. Adequate factor replacement, antifibrinolytics, and careful monitoring are the mainstays of care. The need for frequent venous access can make cannulation of veins difficult, and this can be stressful for the patient and his or her family. Careful planning of any cannulation attempts can alleviate stress, increase success rate, and reduce trauma to veins. If the patient has a long-term central venous line, all precautions to reduce the risk of infection and thrombosis in the line must be adhered to. Development of inhibitory antibodies to factor VIII, or more rarely to factor IX, is currently the most difficult complication to manage in hemophilia patients.
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Patel, Mikin V., and Steven Zangan. Minimally Invasive Repair of Azygos Catheter Migration. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0041.
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Central venous catheters are frequently placed to facilitate the care of patients with multiple conditions, often via jugular approach. Occasionally, the catheter tip can migrate after placement and become positioned within the azygos arch. This abnormal catheter positioning can lead to an increased number of complications, including catheter malfunction, thrombosis, or even rupture of the azygos vein requiring surgical intervention. Although invasive repositioning of the catheter is always an option, minimally invasive options can be attempted to repair azygos catheter malposition. Fortunately, noninvasive maneuvers, including manipulation of the port on the skin and patient breathing instructions, can sometimes repair the malpositioned catheter.
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Kahn, S. Lowell. Balloon-Assisted Removal of the Trapped Catheter. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0048.
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Although uncommon, a trapped central venous catheter (CVC) can present a significant problem for the interventionalist and pose considerable risk to the patient. The use of chronic long-term CVCs is on the rise, with an average catheter dwell time of 10 months. Although all CVCs are prone to complications, chronic catheters exhibit a higher rate of complications. Chronic catheters are also at risk of becoming trapped, whereby they cannot be removed by standard technique. A simple, elegant technique to remove a trapped CVC via inserting an angioplasty balloon into the lumen of a stuck catheter has been described, as has a modified technique with inclusion of a hemostatic sheath and a stiff guidewire inserted into the cut catheter to ensure hemostasis, prevent air embolism or endoluminal thrombosis, and avoid injury to the central veins and heart. Examples of both applications are provided in this chapter.
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Kahn, S. Lowell. Branched Stent Graft Placement in the Vena Cava Using the Endologix AFX. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0031.
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Superior vena cava syndrome (SVCS) comprises a constellation of symptoms resulting from stenosis, occlusion, or thrombosis of the SVC of benign and malignant etiologies. The diagnosis is most commonly seen with thoracic malignancies, with primary lung cancer accounting for up to 70% of cases. Up to 4% of lung cancer patients present with SVCS at the time of diagnosis, and many more develop it at a later time. In younger patients with SVCS, lymphoma is commonly responsible. Recently, there has been a rise in benign SVCS secondary to the increased use of central venous catheters and pacemakers. Endovascular stenting of the SVC for SVCS has been described for more than 25 years and is now the first-line treatment of choice for benign and malignant SVCS. This chapter describes the use of the Endologix AFX AAA system for the treatment of SVCS.
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Alchi, Bassam, and David Jayne. The patient with antiphospholipid syndrome with or without lupus. Edited by Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0164.
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Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent arterial or venous thrombosis and/or pregnancy loss, accompanied by laboratory evidence of antiphospholipid antibodies (aPL), namely anticardiolipin antibodies (aCL), lupus anticoagulant (LA), and antibodies directed against beta-2 glycoprotein 1 (β2GP1). APS may occur as a ‘primary’ form, ‘antiphospholipid syndrome,’ without any known systemic disease or may occur in the context of systemic lupus erythematosus (SLE), ‘SLE-related APS’. APS may affect any organ system and displays a broad spectrum of thrombotic manifestations, ranging from isolated lower extremity deep vein thrombosis to the ‘thrombotic storm’ observed in catastrophic antiphospholipid syndrome. Less frequently, patients present with non-thrombotic manifestations (e.g. thrombocytopaenia, livedo reticularis, pulmonary hypertension, valvular heart disease, chorea, and recurrent fetal loss).The kidney is a major target organ in both primary and SLE-related APS. Renal involvement is typically caused by thrombosis occurring at any location within the renal vasculature, leading to diverse effects, depending on the size, type, and site of vessel involved. The renal manifestations of APS include renal artery stenosis and/or renovascular hypertension, renal infarction, APS nephropathy (APSN), renal vein thrombosis, allograft vasculopathy and vascular thrombosis, and thrombosis of dialysis access.Typical vascular lesions of APSN may be acute, the so-called thrombotic microangiopathy, and/or chronic, such as arteriosclerosis, fibrous intimal hyperplasia, tubular thyroidization, and focal cortical atrophy. The spectrum of renal lesions includes non-thrombotic conditions, such as glomerulonephritis. Furthermore, renal manifestations of APS may coexist with other pathologies, especially proliferative lupus nephritis.Early diagnosis of APS requires a high degree of clinical suspicion. The diagnosis requires one clinical (vascular thrombosis or pregnancy morbidity) and at least one laboratory (LA, aCL, and/or anti-β2GP1) criterion, positive on repeated testing.The aetiology of APS is not known. Although aPL are diagnostic of, and pathogenic in, APS, a ‘second hit’ (usually an inflammatory event) may trigger thrombosis in APS. The pathogenesis of the thrombotic tendency in APS remains to be elucidated, but may involve a combination of autoantibody-mediated dysregulation of coagulation, platelet activation, and endothelial injury.Treatment of APS remains centred on anticoagulation; however, it has also included the use of corticosteroids and other immunosuppressive therapy. The prognosis of patients with primary APS is variable and unpredictable. The presence of APS increases morbidity (renal and cerebral) and mortality of SLE patients.
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Masrani, Abdulrahman, and Bulent Arslan. Deployment of Direct Intrahepatic Portocaval Shunt (DIPS) from a Femoral Access. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0078.
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The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be effective in management of esophageal varices bleeding in patients with liver cirrhosis when endoscopic manuvers fail to control it. Ascites refractory to optimal medical therapy is another indication for TIPS procedure. Occasionally, TIPS cannot be performed due to vascular anatomical difficulties such as occluded central venous access, small hepatic veins, or portal vein occlusion. Direct intrahepatic portocaval shunt (DIPS) can be considered as an alternative option in such circumstances. DIPS is typically performed utilizing jugular access with direct puncture from the inferior vena cava (IVC) to the right portal vein. However, the interventionalist may be challenged by jugular or brachiocephalic veins occlusion. This chapter discusses perfroming DIPS procedure utilizing femoral access in a patient with bilateral occluded brachiocephalic veins and thrombosed right portal vein.
Book chapters on the topic "Central venous thrombosis"
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Roth, Elliot J. "Central Venous Thrombosis." In Encyclopedia of Clinical Neuropsychology. Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-57111-9_2163.
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Roth, Elliot J. "Central Venous Thrombosis." In Encyclopedia of Clinical Neuropsychology. Springer New York, 2011. http://dx.doi.org/10.1007/978-0-387-79948-3_2163.
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Roth, Elliot J. "Central Venous Thrombosis." In Encyclopedia of Clinical Neuropsychology. Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-56782-2_2163-2.
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Blatt, Julie, April M. Evans, and Jessica Benjamin-Eze. "Deep Venous Thrombosis (DVT)/Central Venous Thrombosis." In Manual for Night-Time Emergencies for Pediatric Hematology-Oncology Fellows. CRC Press, 2024. http://dx.doi.org/10.1201/9781003473701-25.
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Athale, Uma, and Anthony Chan. "Central Venous Line-related Thrombosis." In Emergencies in Pediatric Oncology. Springer New York, 2011. http://dx.doi.org/10.1007/978-1-4614-1174-1_12.
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Garrino, Cristina. "Clinical Problems Associated with the Use of Peripheral Venous Approaches in Clinical Practice: Thrombosis." In Peripherally Inserted Central Venous Catheters. Springer Milan, 2014. http://dx.doi.org/10.1007/978-88-470-5665-7_10.
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Robbins, Justin M., Anil Hingorani, and Enrico Ascher. "Acute central venous thrombosis in the setting of central lines, pacemaker wires, and dialysis catheters." In Handbook of Venous and Lymphatic Disorders, 5th ed. CRC Press, 2024. http://dx.doi.org/10.1201/9781003328971-30.
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Cesaro, Simone, and Giulia Caddeo. "Vascular Access." In The EBMT Handbook. Springer International Publishing, 2024. http://dx.doi.org/10.1007/978-3-031-44080-9_23.
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AbstractThe central venous catheter (CVC) is a key tool for patients undergoing hematopoietic cell transplantation. CVC ensures a stable, adequate, and safe venous access. The use of a CVC requires an adequate knowledge and training by health personnel to maintain its functionality and to prevent complications (malfunctioning, partial or complete occlusion, dislodgement, kinking, rupture, thrombosis, and catheter-related bloodstream infections) that can cause the premature removal of CVC or be life-threatening. The choice of CVC must consider the characteristics of the patient, the treatment plan, and the performance expected by the device.
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Vivanco-Allende, Ana, Corsino Rey, Alberto Medina, and Andres Concha. "Thrombosis, Central Venous Lines, and Parenteral Nutrition in Pediatric Intensive Care." In Diet and Nutrition in Critical Care. Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4614-8503-2_122-1.
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Vivanco-Allende, Ana, Corsino Rey, Alberto Medina, and Andres Concha. "Thrombosis, Central Venous Lines and Parenteral Nutrition in Pediatric Intensive Care." In Diet and Nutrition in Critical Care. Springer New York, 2015. http://dx.doi.org/10.1007/978-1-4614-7836-2_122.
Full textConference papers on the topic "Central venous thrombosis"
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Pereira, J., M. Hewicker-Trautwein, M. Depka Prondzinski, and R. Mischke. "Central venous catheter associated thrombosis in dogs." In 27. Jahrestagung der FG „Innere Medizin und klinische Labordiagnostik“ der DVG (InnLab), 2./3. Februar 2019 in München – Teil 2. Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0039-1679119.
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Pereira, JM, M. Hewicker-Trautwein, K. Rohn, M. von Depka Prondzinski, and R. Mischke. "Central venous catheter induced thrombosis in dogs." In 29. Jahrestagung der FG „Innere Medizin und klinische Labordiagnostik“ der DVG (InnLab) – Teil 2: Poster. Georg Thieme Verlag KG, 2021. http://dx.doi.org/10.1055/s-0041-1723884.
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Dantas, Iury Hélder Santos, Iony Santana Santos Dantas, Tereza Cristina Batista Dias, et al. "Cerebral venous thrombosis (CVT) and its interface with arboviroses." In XIV Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2023. http://dx.doi.org/10.5327/1516-3180.141s1.637.
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Introduction: Cerebral venous thrombosis (CVT) is a rare condition. The presence of headache, papilledema, alteration of the VI cranial nerve, focal deficits and changes in consciousness are highlighted. Attention is needed for the interface between arboviruses, and their impact on the Central Nervous System to better understand the disease. This aim is to report a case of CTV, addressing how the arboviroses affect the Central Nervous System. The information contained in this work was obtained through review of the medical record. Case report: A 50-year-old, female, previously healthy sought medical attention due to progressive, squeezing, diffuse headache associated with persistent fever (38 °C), arthralgia and myalgia. Admission exams revealed platelets of 20.000 mm³, positive polymerase chain reaction for dengue and positive immunoglobulin M and negative immunoglobulin G serology. However, during hospitalization, headache intensity worsened, associated with nausea, vomiting, visual blurring and unprecedented tonic-clonic seizures in four limbs. Due to clinical worsening, underwent cranial resonance and angioresonance which revealed venous thrombosis in the transverse and left sigmoid sinus. Absence of changes in the electroencephalogram, lumbar puncture with opening pressure of 25 cmH2O, 10 cells (90% of lymphocytes), no changes in glucose, increase in proteins: 60 mg/dL. On this occasion the platelets were 175.000 mm³. Hematological and rheumatological examinations were normal. Anticoagulation was started with low-molecular-weight heparin and later warfarin 5 mg/day. The patient was discharged without complaints, with oral anticoagulation and follow-up at the CVT outpatient clinic. Conclusion: It is essential to be aware of the alarm signals (red flags) as a form of suspected secondary causes of headache as the TVC, especially in women with persistent headache in the context of arboviroses.
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Gaudencio, Julia Loureiro, Hilton Mariano Mariano da Silva Júnior, and Pedro Neves Fortunato. "Ramsay Hunt Syndrome complicated by Cerebral venous thrombosis (case report)." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.222.
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Context: Ramsay Hunt syndrome is a condition caused by the Varicella-Zoster Virus in the geniculate ganglion and leads to peripheral facial nerve palsy and erythematous vesicular rash in the affected area. It is a rare disorder but is the second most common cause of peripheral facial nerve palsy without trauma. Cerebral venous thrombosis is a rare cerebrovascular disease and responsible for only 0.5% of all strokes. Among its causes are oral contraceptives, infection in the central nervous system, systemic inflammations, and thrombophilia. Case report: We report the case of a previously healthy 29 years old woman diagnosed with Ramsay Hunt syndrome followed by cerebral venous thrombosis two weeks later. Her first admission to the hospital was due to pain in the face and a pulsing type right hemicranial headache. It started in the cervical region and was irradiated to the right retroorbital and auricular area, with difficulty contracting the right eyelid, otalgia, and vertigo. She used oral contraceptives, had two cesarean deliveries, and quitted smoking at 20 years old. She had multidirectional and bilateral nystagmus with fast phase to the left, right peripheral face paralysis, and crusts in the right ear canal. The patient was treated with aciclovir and prednisone, with good recovery. Two weeks later, she returned because of two episodes of convulsion and headache. Brain CTA (computed tomography angiography) showed cerebral venous thrombosis. Conclusion: Cerebral venous thrombosis is a rare complication of Ramsay Hunt Syndrome. It is important to stay alert to the development of vascular complications in these patients.
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Lowe, G. D. O. "EPIDEMIOLOGY AND RISK PREDICTION OF VENOUS THROMBOEMBOLISM." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642965.
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Uses of epidemiology. Venous thromboembolism continues to be an important cause of death and disability in Western Countries. Its epidemiology may provide clues to etiology, e.g. the increased incidence in oral contraceptive users, and the low prevalence at autopsy in Central Africa or Japan compared to the U.S.A. A second use is the monitoring of time-trends: the diagnosis of pulmonary embolism increased during the 1970s, although the case fatality decreased. A third use is the identification and quantification of risk factors: these could be modified in the hope of prevention, or else used to select high risk groups for selective prophylaxis, e.g. during acute illness. Prevention is the only feasible approach to reducing the burden of venous thromboembolism, since most cases are not diagnosed, and since the value of current treatment is debatable.Case definition. Presents problems: clinical diagnosis is unreliable, and should if possible be supported by objective methods. Autopsy studies are performed on selected populations, at a decreasing rate; the frequency of thromboembolism depends on technique; and pathologists cannot be blinded and are open to bias. It can also be difficult to judge whether a patient dying with pulmonary embolism died from pulmonary embolism. 125I-fibrinogen scans indicate minimal disease, and now present ethical problems in screening due to risks of viral transmission. Venography is invasive and is not readily repeatable, which limits its use as a screening method. Plethysmography merits wider evaluation, since it is non-invasive, and sensitive to major thrombosis.Community epidemiology. Data on the community epidemiology are limited. The risk increases with age. When age is taken into account, there is little sex difference. Overweight in women, use of oral contraceptives and blood group A increase the risk: smoking, varicose veins, blood pressure, cholesterol and glucose do not, on current evidence. Long-term follow-up of patients with proven thromboembolism shows an increased risk of malignancy, hence occult cancer may also be a risk factor. Polycythaemia and certain congenital deficiencies (e.g. antithrombin III) are also well-recognised risk factors, although uncommon.Hospital epidemiology. Data on hospital epidemiology are derived largely from autopsy prevalence, and from short-term incidence of minimal thrombosis detected by 125I—fibrinogen scanning. Old, immobile and traumatised patients are most at risk. Previous thromboembolism, polycythaemia, antithrombin III deficiency, hip and leg fractures, elective hip and leg surgery, hemiplegia, paraplegia, and heart failure carry high risks, and merit consideration for routine prophylaxis. The risk in elective surgery precedes the operation, and increases with age, overweight, malignancy, varicose veins, non-smoking, and operative factors (duration, approach, general anaesthesia, intravenous fluids). Diabetics appear to have no extra risk. Combinations of clinical variables can be used to predict high risk groups for selective prophylaxis, but combination indices require further study. Laboratory variables may increase the predictability of deep vein thrombosis, but the results of published studies are conflicting, and the cost-effectiveness of laboratory prediction should be evaluated.
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Vilella, Amanda Mendes Clemente, and Letícia Luísa Mattos. "Cerebral venous thrombosis related to the use of combined oral contraceptives." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.514.
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Background: Cerebral venous thrombosis (CVT) is a rare condition (less than 1% of stroke). It occurs in the younger population (less than 50 years old), 3 times more common in women, especially those of reproductive age. Objectives and methodology: Narrative review to correlate CVT with the use of combined oral contraceptives (ACO). The following databases were used: Pubmed, Scielo and Medline. Results: A systematic review had 11 studies included showing that the use of OAC increases the chances of developing CVST (central venous sinus thrombosis). Among the 9 studies that reported odds ratios, the combined probability of developing CVST in women of reproductive age who use OAC was 7.59 times the probability of developing CVST compared to those who do not take oral contraceptives (OR = 7.59, 95 CI % 3.82-15.09). A retrospective study of 37 female adolescents was diagnosed with CVT, 22 (59%) of whom used OAC and the remaining 15 had other etiological factors. The data indicate that adolescents using OAC to treat hirsutism, menstrual dysfunction or polycystic ovary syndrome may also have some risk factors for thrombosis, such as hereditary coagulopathy. The coexistence of these diseases mentioned with the use of OCA can increase the risk of CVT. Conclusions: The two main studies analyzed concluded the association between the use of ACO and cases of CVT in women. It’s necessary to be attentive to suggestive signs and symptoms in this population, as they are common to other pathologies, making the diagnosis of CVT difficult.
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Nielsen, T. H., H. K. Nielsen, S. E. Husted, S. L. Hansen, and K. H. Olsen. "PLATELET FUNCTION AND ENDOCRINE STRESS RESPONSE DURING BUPIVACAINE EPIDURAL ANALGESIA. THE EFFECT OF MORPHINE ADDITION." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644887.
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Platelet aggregation plays a central role in thromboembolism. Epidural analgesia can diminish the formation of deep venous thrombosis. In a randomized study twenty patients admitted to transartliroscopic meniscectomy were allocated to epidural analgesia with or without morphine epidurally. S-cortisol, s-thromboxane -B2(s-T2 B2) and platelet aggregation were measured before premedication, when epidural block extended from S3to T5, just before skin closure and exsufflation of tne thigh tourniquet, and the last sample was taken ten min after exsufflation. Aggregability was measured in platelet-rich plasma and expressed as the treshold concentration of collagen. Cortisol and T Bp were measured by RIA.S-cortisol decreased duringxanalgesia in the morphine group (p<o.o5), and during operation in both groups (p<o.o5) being significant lower in the morphine group (p<o.o5).S-TxB2 decreased significantly in the morphine group during analgesia, but there was no significant difference in s-TxB2 between the two groups. Treshold concentration of Collagen for aggregation of platelets showed an insignificant increase for both groups during analgesia, but did not differ between the two groups. Removal of the tourniquet did not influence any of the measurements. It is concluded that additionof morphine to bupivaca- ine epidural analgesia further decrease activity of the adrenocortical system, and the combined regime seems to inhibit platelet function in the same manner as monotherapy with local anaesthetics.
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Mattos, Letícia Luísa, and Amanda Mendes Clemente Vilella. "COVID-19 and the central nervous system: what is more frequent?" In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.419.
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Background: In 2020, SARS-Cov-2 was identified as responsible for pneumonia in Wuhan and declared by WHO to be a pandemic. The action of SARSCoV-2 with the angiotensin-converting enzyme 2 and the cytokine storm, can trigger acute cerebrovascular diseases, meningoencephalitis, arterial dysregulation and possible neurological consequences. With the involvement of the central nervous system (CNS), it is necessary to alert professionals to a possible increase in acute neurological cases and long-term follow-up. Objectives and methodology: To analyze the occurrence of signs and symptoms related to the COVID-19 infection, seeking to establish the most common and the most serious ones, through narrative review. Results: The symptoms related to the CNS were described in all the studies analyzed, with a higher occurrence of headache, altered level of consciousness, dizziness, myalgia, hypogeusia and hyposmia. Other quotes, to a lesser extent, were neuralgia and seizure episodes. Among the most worrying findings are cerebrovascular events, acute hemorrhagic necrotizing encephalopathy and GuillainBarré syndrome. As for cerebrovascular diseases, ischemic injuries and venous thrombosis can occur, from asymptomatic cases to severe cases. The importance of pre-existing risk factors in the cerebrovascular outcome is highlighted. Conclusions: Although the symptoms of primary infection are nonspecific and easily confused, CNS involvement can be fatal, citing cerebrovascular involvement as the most worrying finding. The occurrence of pre-existing risk factors should take the attention of the health professional, however, those who do not have them must also be carefully investigated from the signs and symptoms presented.
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Backhouse, C. M., D. AJ Galvin, R. A. Harper, A. C. Meek, and C. N. McCollum. "PARTICULATE CONTAMINATION OF DRUGS: THEIR EFFECT ON PLATELET KINETICS AND THE PULMONARY CIRCULATION." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644867.
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More than 107 particulate contaminants >2um and many more <2um are infused daily in parenteral medications to intensive care patients. They may form emboli with aggregated platelets and damage pulmonary vasculature [1], perhaps contributing to alveolar fibrosis in very premature babies. We studied this possibility in neonatal pigs.Nineteen newborn pigs were randomised to either daily 0.2um filtered salineas controls, or infusions of particles similar to drug contaminants at 10x greater than the patient equivalent dose/kg given via subcutaneous injection portals with tunnelled central venous catheters. Four weeks later, autologous platelets were labelled with llllndium and arterial and Swann Ganz catheters inserted under general anaesthesia. Before particle or filtered saline infusion and at 5 and 20 minutes later platelet count, lung platelet uptake, mean arterial pressure (BP), pulmonary vascular resistance, pulmonary shunt and alveolar-arterial P02 difference were measured.Initially, there were no significant differences between the groups indicating no measureable effect from chronic particle dosing over 4 weeks. Within 30 sec of bolus particle injection BP fell from a mean ( ± sem) of 68.9+2.1mmHg to 61.0±2.1 (p<0.01, paired t-test) but returned to normal within 5 minutes. This was not seen with controls or particle injections given over 5 minutes. Platelet counts fell in the particle group from 660±43 (x109/L) to 584±46 at 20 minutes (p<0.01) but lung platelet accumulation was insignificant.Transient fall in blood pressure due to contaminating particles can be avoided by slow injection or 0.2um in-line filters. Particles stimulate a loss of circulating platelets but with insignificant pulmonary accumulation and no impairment of pulmonary function after 4 weeks of daily particle injection at considerably higher doses than patients receive.1. Chia C, Cattell V. The role of platelets in mesangial localisation: carbon uptake in thrombocytopaenic rats. BrJ Exp Path 1985; 66: 465-474.
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Poniewierski, M., M. Barthels, and H. Poliwoda. "THE SAFETY AND EFFICACY OF A LOW MOLECULAR WEIGHT HEPARIN (FRAGMIN) IN THE PREVENTION OF DEEP VEIN THROMBOSIS IN MEDICAL PATIENTS: A RANDOMIZED DOUBLE-BLIND TRIAL." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643224.
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The safety and efficacy of 2500 anti-Factor Xa U of a low molecular weight heparin (Kabi 2165, Fragmin) subcutaneously once a day, and 5000 IU of standard unfractionated Heparin (KabiVitrum, Stockholm) subcutaneously twice daily as thromboprophylaxis was compared in 200 medical patients in a randomized double blind trial. According to the risk of DVT the patients were stratified before randomization in a high and low risk group. The high risk group consisted of 100 patients mainly with malignant diseases and/or previous history of thromboembolism, the low risk group of 100 patients with mainly myocardial infarction and/or coronary heart disease. The prophylaxis was given for seven to ten days. In 192 consecutive patients the clinical status and thermographic screening for DVT (leg temperature profiles, DeVeTherm) were daily evaluated. In two cases of suspected DVT and one case of suspected PE, the following phlebography or pulmonary scintigraphy were found to be negative. In the high risk group, one patient treated with Fragmin having a central venous catheter developed on day 10 symptoms of an arm vein thrombosis. There were no bleeding complications observed in either of the two treatment groups. Two patients with trombocytopenia (25.000 and 22.000/pl) due to chemotherapy and underlying malignant disease were successfully treated with Fragmin without developing any bleeding complications. In eight patients during Fragmin prophylaxis invasive diagnostic methods as heart catheterization, gastroscopy, bronchoscopy or spinal puncture were performed without noticing any bleeding events. 2500 anti-Factor Xa U of Fragmin gave plasma levels by anti-Factor Xa assay (S-2222, Kabi) of mean 0,1 U/ml when blood was sampled three to four hours after the subcutaneus application. There was no accumulation during the treatment periode observed.This study suggests that 2500 anti-Factor Xa U of Fragmin once daily is as safe and effective as 5000 IU of standard heparin twice daily in these medical patients. Especially in patients who need prophylaxis for a long time eg. with malignant disease, the once daily injection is welcomed.