Equis ISSN 2398-2977

Anesthesia: peri-operative complications - jugular thrombophlebitis

Synonym(s): Thrombophlebitis

Contributor(s): Regula Bettschart, Mark Senior

Introduction

  • Thrombophlebitis (TP) is inflammation of a vein associated with a clot of blood. It is the most common reported complication of catheterization in veterinary medicine. Septic thrombophlebitis (STP) is where the inflammation is accompanied by a bacterial infection.
  • The jugular vein is the most commonly catheterized vein in horses, any TP/STP of the jugular vein may have serious consequences.

Risk factors

  • Patient related factors:
    • Malnutrition/debilitation.
    • Impaired immune status, eg neonates.
    • Concurrent infections/bacteremia/endotoxemia.
    • Skin infection.
    • Coagulopathies.
  • Catheter related factors:
    • Certain materials are less thrombogenic than others, eg polypropylene> polytetrafluoroethylene (PTFE/ Teflon)> silastic> PVC> polyurethane BUT in vitrothe softness of the material also plays a role so in some studies silastic catheters were less thrombogenic c.f. polyurethane. Some materials, eg polyurethane are available impregnated with bacteriostatic/bacteriocidal agents to further reduce bacterial colonization and risk of STP. Some materials may not be appropriate for use in horses as are expensive and/or only available in small gauges.
    • The more material a catheter has that can be in contact with the vessel lining means more thrombogenicity: thus larger bore, longer catheters will cause more reaction. The reason most long stay catheters are long is partly due to the fact that a longer catheter is less likely to be pulled out of a vein but also because most of these catheters are designed for use in humans and so a 30 cm catheter 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. In a horse such a catheter will just lie for 30 cm along the wall of the jugular vein!
    • Duration of dwelling in vein.

Check with manufacturer how long catheter types are designed to remain in a vein, eg Teflon catheters should not be left in situfor more than 24 h.

  • Catheter placement/care:
    • Lack of aseptic placement.
    • technique of placement: Over-the-wire (Seldinger) or Through-the-cannula (peel-away) catheters are less likely to be associated with problems than Over-the-needle catheters.
    • Mechanical trauma to vessel and surrounding tissues: poor placement, catheter not secured properly, catheter kinked, etc.
    • Catheter causing turbulent flow of blood will increase thrombus formation, ie a catheter placed against the flow of blood/up the vein.
    • Catheter not flushed regularly: indwelling catheters should be flushed 4-6 times daily.
    • Lack of care in maintenance of clean/aseptic handling of catheter, eg bottle tops and bungs not swabbed with spirit, etc.

Competence in performing these techniques is very important.

  • Drug administration:
    • Total Parental Nutrition (for TPN a double lumen catheter should be used to avoid irritation of the vein).
    • Certain drugs are irritant when administered intravenously, eg hypertonic fluids, thiopental, guaifenesin   Guaifenesin  .
    • Home made intravenous solutions are more likely to cause thrombophlebitis.

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

  • Tan R H H et al (2003) Catheters: a review of the selection, utilisation and complications of catheters for peripheral venous access. Aust Vet J 81, 136-139 PubMed.
  • Barakzai S & Chandler K (2003) Use of indwelling catheters in the horse. In Pract. 264-271.
  • Lankveld et al (2001) Factors influencing the occurrence of thrombophlebitis after post-surgical long-term venous catheterization of colic horses: a study of 38 cases. J Vet Med Assoc 48, 545-552 PubMed.
  • Rijkenhuizen A B & van Swieten H A (1998) Reconstruction of the jugular vein in horses with post thrombophlebitis using saphenous vein graft. Equine Vet J 30, 236-239 PubMed.
  • Traub-Dargatz J L & Dargatz D A (1994) A retrospective study of vein thrombosis in horses treated with intravenous fluids in a veterinary teaching hospital. J Vet Intern Med 8, 264-266 PubMed.
  • Gardner S Y et al (1991) Ultrasonographic evaluation of horses with thrombophlebitis of the jugular vein: 46 cases (1985-1988). JAVMA 199, 370-373 PubMed.
  • Spurlock S L et al (1990) Long-term jugular vein catheterization in horses. JAVMA 196, 425-430 PubMed.

Other sources of information

  • Spurlock S L & Spurlock G H (1990) Risk factors of catheter related complications. Continuing Education Article #8. In: Proc 11th ACVIM Forum.


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