ISSN 2398-2993      

Thrombophlebitis

obovis
Contributor(s):

Gayle Hallowell

Alex Dugdale

University of Nottingham logo


Introduction

  • Thrombophlebitis (TP) is inflammation of a vein associated with a clot of blood.
  • It is the most commonly reported complication of venous cannulation in veterinary medicine.
  • Septic thrombophlebitis (STP) is where the inflammation is accompanied by a bacterial infection.
  • The jugular vein is the most commonly cannulated vein in cattle, although cephalic veins can also be effectively utilised. TP/STP of the jugular vein may have serious consequences.
  • This condition is rarely seen in cattle as cannulas are usually only placed for short-term use and can be difficult to maintain.
Cattle are particularly dextrous at removing jugular venous cannulas with hind-feet and so, if left unattended, jugular venous cannulas should always be wrapped to prevent cannula loss and damage to the vein.
Risk factors
  • Patient related factors:
    • Malnutrition/debilitation.
    • Impaired immune status, eg neonates or sepsis.
    • Concurrent infections/bacteraemia/SIRS.
    • Skin infection.
    • Coagulopathies.
  • Cannula related factors:
    • Certain materials are less thrombogenic than others, eg polypropylene> polytetrafluoroethylene (PTFE/ Teflon) > silastic > PVC > polyurethane BUT in vivo the softness of the material, which may increase at body temperature, also plays a role. In some studies, silastic cannulas were less thrombogenic c.f. polyurethane. Some materials, eg polyurethane are available impregnated with bacteriostatic/bacteriocidal agents to further reduce bacterial colonisation and risk of STP. Some materials may not be appropriate for use in cattle due to cost or lumen diameter too small. 
    • The more material a cannula has that can be in contact with the vessel lining means more thrombogenicity: thus larger bore, longer cannulas will cause more reaction than narrower, shorter ones. The reason most long stay cannulas are long is partly due to the fact that a longer cannula is less likely to be pulled out of a vein but also because most of these cannulas are designed for use in humans and so a 30 cm cannula in a person will lie in mid-flow of the blood in a central vein and thus will not cause much irritation to the tunica intima of the vessel. 
    • Duration of dwelling in vein.
Check with manufacturer the duration for which the various different cannula types are designed to remain in a vein, eg Teflon cannulas should not be left in situ for more than 24-48 h.
  • Cannula placement/care:
    • Lack of aseptic technique.
    • Technique of placement: over-the-wire (Seldinger) or through-the-cannula (peel-away) cannulas are less likely to be associated with problems than over-the-needle cannulas.
    • Damage to cannula when placed, eg an incision through the skin is essential in cattle due to thickness of skin. Trying to insert a cannula without a skin incision results in damage in the distal portion of the cannula. It also means that a piece of skin passes into the jugular vein, which will contain skin commensals that can colonise.
    • Mechanical trauma to vessel and surrounding tissues: poor placement, cannula not secured properly, cannula kinked etc.
    • Cannula causing turbulent flow of blood will increase thrombus formation, ie a cannula placed against the flow of blood/up the vein.
    • Cannulas should be sutured securely to the skin in order to minimize movement of the cannula thus minimising damage to the intima of the vein.
    • Cannula not flushed regularly: indwelling cannulas should be flushed regularly.
    • Lack of care in maintenance of clean/aseptic handling of cannula, eg bottle tops and bungs not swabbed with spirit etc.
Competence in performing these techniques is important.
  • Drug administration:
    • Total Parental Nutrition (for TPN a double lumen cannula should be used to avoid irritation of the vein) or 40-50% dextrose/glucose as these solutions are hypertonic/hyperosmotic.
    • Certain drugs are irritant when administered intravenously, eg hypertonic fluids, particularly hypertonic saline, thiopental, Metamizole Metamizole (dipyrone), (guaifenesin – not licensed in cattle in most regions).
    • Home-made intravenous solutions may be more likely to cause thrombophlebitis. Fluid therapy

Etiology

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Diagnosis

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Treatment

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Sequelae/complications

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Prevention

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMed Resource.
  • Tan R H H et al (2003) CannulaCannulas: a review of the selection, utilisation and complications of cannulacannulas for peripheral venous access. Aust Vet J 81, pp 136-139.

Other sources of information

  • Valverde A & Sinclair M (2015) Ruminant Anesthesia. In: Veterinary Anesthesia and Analgesia. Blackwell Publishing.
  • Clarke K & Trim C (2014) Patient Monitoring and Clinical Measurement and Anaesthesia of Cattle. In: Veterinary Anaesthesia. 11th Edn. Elsevier.
  • Spurlock S L & Spurlock G H (1990) Risk factors of cannula related complications. Continuing Education Article #8. In: Proc 11th ACVIM Forum.

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