Subclavian vein thrombophlebitis: complication of total parenteral nutrition (TPN)

ABSTRACT

A retrospective analysis of 1311 patients who underwent 1611 central venous catheterizations for total parenteral nutrition (TPN) showed clinical subclavian and central venous thrombophlebitis in 11 patients (0.8%). Catheter-related complications occurred in 9.6% of the patients. Of 11 patients with thrombophlebitis, 10 were female, and half of the patients had ulcerative colitis or Crohn’s disease. Fifty percent of the patients had multiple punctures and catheter malposition. In 3 patients the diagnosis of central venous thrombophlebitis was made within four days, and in 6 patients, within two to four weeks of catheter insertion. The initial symptoms in 81% of the patients were fever, chills, diaphoresis, and severe pain including the arm, axilla, neck, and pectoral areas followed by edema and superficial collateral venous distention. Internal jugular occlusion in 5 patients, extension into the superior vena cava in 5 patients, and right atrium involvement in one patient were noted. Staphylococcus bacteremia was documented in 6 patients with the onset of symptoms. There was one fatality due to pulmonary embolism. Eight patients are alive and well and 2 of them have chronic edema of the arm. Two patients died of causes unrelated to subclavian vein thrombosis or TPN.