This always is an interesting topic as there is little data about an internal jugular vein DVT associated with a catheter. Since almost all catheters cause some thrombus formation, I think it is reasonable to consider this an acute DVT. It would be interesting if a study was performed to compare these symptoms as to whether DVT treatment or NSAIDS are better. We always treated these as DVT and found a few cases of HIT in these patients. I think the main thing to do is to not change the catheter site. Treat the thrombus and/or symptoms with plans to remove the catheter once a permanent access is in place.

So....should these cases have an ultrasound evaluation to look for acute thrombus associated with the catheter? If acute thrombus is identified, then what?

There is the problem: there is no data here. Most of the consensus that I have seen is to treat as a symptomatic DVT (asymptomatic thrombus: do nothing) and do not remove the catheter (unless there is a different reason to do so).

Dear colleagues,
This is indeed an acute thromboPHLEBITIS and should be treated as a SYMPTOMATIC acute DVT. It can or cannot be associated with bacteremia (I could not attach the pictures to illustrate).
Ultrasound is important to diagnose the acute thrombus (since they present with ipsilateral swelling of the neck and severe tenderness, it is important to r/o other causes of swelling, hematoma, abscess, etc).
Blood cultures are always important to do with empiric coverage until the results are back.
The treatment is hospitalization with heparin and coumadin therapy (alternative options such as adjusted dose lovenox and eliquis are at ur discretion) for the life of the catheter or for at least 3 months if the TDC is removed sooner.
If there is a concomitant infection/bacteremia, appropriate course of ABx along with TDC Exchange (when appropriately anti coagulated/treated with ABx and symptoms subsided) is also recommended.
There is NO need to remove the catheter. We already caused damage to one vessel, it is not wise to cause harm to others.
These are my 2 cents...
Thx
Tony Samaha

All too often, these patients present to an ER, get diagnosed with a clot, get put on heparin, have the catheter pulled and then are placed on weeks to months of oral anticoagulation. They are then referred for an AVF and the surgery gets delayed d/t to "need" for long-term anticoagulation.

I agree, there is no real literature on this. Some have extrapolated from some information regarding chemotherapy ports and clots, but it is not the same. Our patients have platelet dysfunction and issues with VWB like factors and don't act like others with clots. Plus, the clot is absolutely due to the catheter and is very unlikely to propagate or cause and issue. I'd treat symptomatically (agree with cultures and antibiotic pending results) and barring other problems, leave the catheter in place and not do long-term anti-coagulation ,

jp

There is a difference between thrombophlebitis and phlebothrombosis. The first is associated with inflammation, the thrombus is attached to the vessel wall and embolization is very uncommon. Phlebothrombosis on the other hand is thrombus in a vein with no associated inflammation. The thrombus is not attached to the wall and is very much subject to embolization.
The goal of chronic anticoagulation therapy is to prevent clot propagation and embolization. This is indicated in phlebothrombosis, but not so much in thrombophlebitis.
Then there is the legal issue.