Endothelial Thrombus Formation: An Unusual Complication Related to Peripherally Inserted Central Catheters

Abstract

The Nutritional Support Service (NSS) at William Beaumont Hospital has successfully inserted over 2000 peripherally inserted central catheters (PICCs) since the inception of its PICC program in 1990. The following is a case study of a 43-year-old female with diabetes mellitus and multiple drug allergies who presented to the NSS after Wound Clinic personnel were unable to pull a 43 cm PICC more than 38 cm out of her left arm. Radiographic studies showed the remaining 5 cm of the catheter to be untangled, following the course of the cephalic vein. A surgical cutdown was performed to dilate the cephalic vein and remove the device. The PICC tip was encapsulated in an organic material which was confirmed by pathology to be a thrombus with endothelial lining.

Get full access to this article

View all access options for this article.

References

Poisson DM , Touquet S. , Bercault N. , et al. Electron microscopic descriptions of accretions occurring on tips of infected and noninfected central venous catheters. Intensive Care Med 1992;18:464-8.

Borow M. , Crowley JG Evaluation of central venous catheter thrombogenicity. Acta Anaesth Scand 1985;81 (suppl):59-64.

Moss JF , Wagman LD , Riihimaki DU , et al. Central venous thrombosis related to the silastic Hickman Broviac catheter in an oncologic population. JPEN 1989;13:397-400.

Bosserman G. , Williams K. , McGuire W. Prospective study of 104 silastic catheters and the significance of variables related to thrombus . Oncol Nurse Forum 1990;17(suppl):195.

Ryder MA : Peripherally inserted central venous catheters. Nurs Clin North Am 1993;28:937-71.

Orr ME Issues in the management of percutaneous central venous catheters . Nurs Clin North Am 1993; 28:911-919.

Hsueh WA , Anderson PW Hypertension, the endothelial cell and the vascular complications of diabetes mellitus. Hypertension 1992;20:253-63.

Cassidy FP , Zajko AB , Bron KM , et al. Noninfectious complications of long-term central venous catheters: radiologic evaluation and management. AJR 1987;149:671-5.

Schneider TC , Krzywda E. , Andris D. , et al. The malfunctioning silastic catheter-radiologic assessment and treatment. JPEN 1986;10:70-3.

10.

Bern MM , Lokich JJ , Wallach SR , et al. Very low doses of warfarin can prevent thrombosis in central venous catheters. Ann Inter Med 1990;112:423-8.

11.

Food and Drug Administration. Rockville, MD Central venous catheter complications. 3 Part video series, 1994.