Authors’ recommendations for management of CRT
| Prevention . | Diagnosis . | Treatment . |
|---|---|---|
| Place CVAD in subclavian > jugular > femoral insertion site. | Ultrasound to confirm suspected thrombosis. | Anticoagulation for 3 mo or until CVAD removed (whichever is longer). |
| Place port > Hickman > PICC. | No ultrasound surveillance. | Thrombolysis for limb-threatening CRT or severe symptoms and failure to respond to AC. |
| Place smallest caliber catheter necessary. | CT (or MRI) venography to confirm suspected thrombosis in patients with negative venous ultrasound. | CVAD removal if AC contraindicated or infected or no longer needed (add AC if contraindication resolves). |
| Place catheter tip at SVC-RA junction. | Avoid SVC filter use. | |
| Do not use anticoagulant thromboprophylaxis. | Graduated compression garment for symptomatic upper extremity PTS but not PTS prevention. |
| Prevention . | Diagnosis . | Treatment . |
|---|---|---|
| Place CVAD in subclavian > jugular > femoral insertion site. | Ultrasound to confirm suspected thrombosis. | Anticoagulation for 3 mo or until CVAD removed (whichever is longer). |
| Place port > Hickman > PICC. | No ultrasound surveillance. | Thrombolysis for limb-threatening CRT or severe symptoms and failure to respond to AC. |
| Place smallest caliber catheter necessary. | CT (or MRI) venography to confirm suspected thrombosis in patients with negative venous ultrasound. | CVAD removal if AC contraindicated or infected or no longer needed (add AC if contraindication resolves). |
| Place catheter tip at SVC-RA junction. | Avoid SVC filter use. | |
| Do not use anticoagulant thromboprophylaxis. | Graduated compression garment for symptomatic upper extremity PTS but not PTS prevention. |
AC, anticoagulation; CT, computed tomographic; MRI, magnetic resonance imaging; RA, right atrium.