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PubMed1997

Ultrasonographic investigation of the pathogenesis of infusion thrombophlebitis.

BACKGROUND: Thrombophlebitis frequently complicates intravenous infusion, but its precise pathogenesis remains unclear. METHODS: Serial B mode ultrasonographic imaging was used to detect intraluminal thrombosis when intravenous nutrition was delivered via fine-bore catheters inserted into peripheral veins. RESULTS: Thrombus was detected in 14 of 22 catheterized veins. There were nine episodes of clinical phlebitis; each was associated with intravenous thrombosis. Venospasm was not observed. The time at which thrombus was first detected varied from within 24 h to more than 15 days after catheterization. Detection of intravenous thrombosis within 24 h of catheter insertion was associated with early catheter complications. Early thrombus tended to be found close to the site of venepuncture, whereas late thrombus was found at the catheter tip, where the hypertonic feed was delivered. DISCUSSION: Ultrasonographic imaging was a useful technique for investigation of infusion thrombophlebitis. Two patterns of thrombosis were observed: distal early thrombosis and proximal late thrombosis. Information acquired may help in the design of novel catheters and strategies to reduce the incidence of thrombophlebitis.

Aged↗
PubMed1998

[Peripheral arterial complications after heart catheterization].

After diagnostic and interventional cardiac catheterization, local vascular complications at the arterial entry site must be expected. With respect to the method applied for catheterization and the puncture site, the type of complications may vary. With transfemoral approach a large variety of vascular complications have to be feared, mostly in the form of bleeding complications and hematomas, arterial dissections or occlusions, pseudoaneurysms and AV-fistulas. Each of these complications may have the potential for serious morbidity. When cardiac catheterization is performed via the arteries of the arm (either in the classical Sones technique by arterial cutdown to the brachial artery or by direct puncture of the brachial or radial artery) vascular occlusions will mostly occur as local vascular complications. These occlusions can often be managed conservatively or by a surgical procedure. The incidence of a vascular complication is mainly dependent on patient-related (sex, age, height, weight, arterial hypertension, diabetes, presence of peripheral vascular disease and compliance of the patient after withdrawal of the sheath) and procedure-related (arterial access site, diagnostic or interventional study, sheath size, periprocedural anticoagulation, duration of intra-arterial sheath placement, faulty puncture technique, operator skill) factors. In addition, the definition of a complication, the publication year of a certain study and the technique used for identification of complications seem to play a role for the reported incidence of peripheral vascular complications after cardiac catheterization. Currently, incidences of 0.1 to 2% for significant local vascular complications after diagnostic transfemoral catheterization are reported, after interventional transfemoral treatment 0.5 to 5% and after complex procedures using large sheath sizes with periprocedural anticoagulation (directional atherectomy, IABP, left-heart assist, valvuloplasty) up to 14%. Following transbrachial and transradial catheterization, local vascular complications at the entry site amount to 1 to 3% after diagnostic and 1 to 5% after interventional procedures. Local vascular complications may be diminished by a cautious and sensitive puncture technique with additional care in patients at higher risk for vascular complications (females, prediagnosed peripheral vascular disease, mandatory anticoagulation, necessity for large sheaths). By using smaller sized catheters and an adequate, defensive anticoagulation regimen, the rate of arterial access site complications may be reduced. Proper methods for achievement of hemostasis as well as a close and careful observation after sheath withdrawal are required.

Angioplasty, Balloon, Coronary↗