Phlebography in long-term catheterization of the subclavian vein. A retrospective study in patients with severe gastrointestinal disorders.

The frequency of superior central venous thrombosis was studied in a consecutive retrospective series of 27 patients with severe gastrointestinal disorders in whom long-term catheterization of the subclavian vein for parenteral nutrition was carried out. The patients had 35 periods of catheterization ranging from 14 to 766, mean 86, days and a total of 51 catheter periods. Only one patient showed clinical signs of thrombosis in spite of phlebographic findings revealing seven cases of central venous thrombosis. Recanalization was not seen. Exchange of catheter was performed 17 times in 10 patients using the Seldinger technique. This did not influence thrombosis rate. Septicaemia was found in five patients subsiding after catheter exchange. No fatalities occurred, and no correlation between the septicaemia and thrombosis rate was found. Catheters used for more than 100 days showed changes of mechanical properties. It is therefore advisable to exchange catheters after 3 months' use by the Seldinger technique. The discrepancy between the clinical and phlebographic findings emphasizes that repeated subclavian catheterization should be preceded by bilateral phlebography.