Axillary and subclavian venous thrombosis: prognosis and treatment
The axillary and subclavian veins are large veins that return blood from the arms to the heart, and run from the armpit to the area under the clavicle, or collarbone. The formation of blood clots, or thrombi, in these veins has been reported, and can have severe consequences. Axillary and subclavian vein thrombosis, ASDVT, can occur in several clinical situations: spontaneously, especially after strenuous effort; in association with large indwelling intravenous catheters, such as those used for nutrition and dialysis; and other causes, such as intravenous drug use and tumors in the chest. Treatment consists of local measures, including heat and elevation. Blood-thinning drugs, such as intravenous heparin or oral warfarin, are often administered as well. These anticoagulants prevent clots from breaking apart. Other agents sometimes used to treat ASDVT include thrombolytic agents, such as streptokinase, which dissolve clots. Some cases are treated surgically, by opening the vein and removing the clot or by removing an obstruction to blood flow through the vein, such as an unusually shaped rib or collarbone. Some of the adverse effects of ASDVT include the superior vena cava syndrome, in which the return of blood flow from the head to the heart is obstructed, resulting in severe swelling of the head, neck and arm, and pulmonary embolism, in which pieces of the blood clots break away and lodge in the circulation of the lungs. Three deaths from pulmonary embolism resulting from ASDVT have been reported in the medical literature. The studies of ASDVT are mostly case reports, and thus extrapolating advice for the treatment of this condition is difficult. However, the reports seem to suggest that the use of anticoagulants may be indicated to prevent the possible complication of pulmonary embolism. Because ASDVT appears to be common with the use of large intravenous catheters in the axillary and subclavian veins, prophylactic use of low doses of blood thinners may be warranted. Surgery may be warranted when the abnormalities leading to the ASDVT are obviously correctable. Controlled studies of ASDVT and its treatment and outcomes would be useful in making future recommendations. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Guidelines on management of peripheral arterial disease
Peripheral arterial disease (PAD) of the legs is a condition where there is a wide variety in management diagnostic investigations and referral criteria. An approach to management is presented that highlights the importance of addressing cardiovascular risk factors in patients with PAD.
Publication Name: Nursing Times
Combating phlebitis: a peripheral cannula grading scale
The causes of infusion-related phlebitis are considered. The use of a peripheral cannula grading scale and the action to be taken if phlebitis occurs are discussed.
Publication Name: Nursing Times
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