Subclavian vein thrombosis during prolonged catheterization for parenteral nutrition: early management and long-term follow-up.

The purpose of this study was to determine the immediate and long-term complications of subclavian vein thrombosis occurring during prolonged catheterization for parenteral nutrition. Ten cases of subclavian vein thrombosis documented by venography were initially treated by catheter removal, systemic heparin, and upper extremity elevation. Although fever was common (N = 9), only three patients had positive blood or catheter cultures and only one patient required antibiotic therapy. Nonfatal pulmonary embolism was suspected by lung scan in only one patient. After a follow-up period of six months to five years (mean two years), no long-term disability, such as arm swelling or pain, was identified. We conclude that immediate and late sequelae of catheter-associated subclavian vein thrombosis are minimized by prompt removal of the catheter, systemic administration of heparin to prevent clot propagation and embolism, and arm elevation to reduce early upper extremity edema.