• Twitter
  • Facebook
  • Vimeo
  • FCUS Courses
  • Register for FCUS Course
  • Login
Intensive Care Network
  • About Us
    • What is ICN
    • Our Team
  • Events
  • Podcast Series
    • Podcast by Topic
      • Airway Podcasts
      • Cardiac Podcasts
      • Career Podcasts
      • Conference Podcasts
      • Education Podcasts
      • Evidence Podcasts
      • GI/Renal Podcasts
      • Haem Podcasts
      • Metabolic Podcasts
      • Miscellaneous Podcasts
      • Neuro Podcasts
      • Paeds Podcasts
      • Respiratory Podcasts
      • Resuscitation Podcasts
      • Sepsis Podcasts
      • Toxicology Podcasts
      • Trauma Podcasts
      • Ultrasound Podcasts
    • Podcast by Specialty
      • Anaesthetics
      • Emergency
      • ICU
      • Prehospital
    • SMACC
    • ICN
    • Jellybean
    • CICM ASM
  • Blog
  • Resources
    • Clinical Cases
    • Fav Posts/Other Sources
    • Game Changing Evidence
    • Radiology
      • ICU Radiology
    • Simulation Resources
    • Ultrasound
      • Lung Ultrasound
  • EXAMHELP
    • ANAESTHETICS PRIMARY
    • ANZCA FELLOWSHIP
    • CICM Fellowship
    • EMERGENCY PRIMARY
    • ICU Primary Exam
    • PAEDS FELLOWSHIP
  • Contact Us

ICN Hot Case #10

Home ICN Hot Case #10

You have just reached Bed 3 on the ICU ward round. The 68yo male patient was admitted to the unit 6 days ago with a community acquired pneumonia. He is weaning off the last of his vasopressor infusion and will finish his antibiotics in the next 48 hours or so. The nurse makes a beeline for you.

She expresses her concern that the patient’s right arm appears to have increased in volume over the past 24 hours. She has already notified the resident, who diligently pushed for a vascular ultrasound, the outcome of which is a 3cm thombus that borders between the proximal brachial and distal axillary vein of the right upper limb.

 

 

[su_tabs]
[su_tab title=”Question”]

How will you manage this diagnosis?

[/su_tab]
[su_tab title=”Answer”]

Upper limb DVT management has been a bit of a black spot, as far as best practice management is concerned. It is essentially a (high quality) evidence free zone.However, its incidence may be on the increase as procedures associated with its occurence become more prevalent.

Upper limb DVTs account for under 10% of all DVTs, but 5% may go on to result in a PE. About three-quarters of upper limb DVTs are attributed to venous catheters, pacemaker wires or underlying cancer.

The American College of Chest Physicians recently published their Antithrombotic Therapy and Prevention of Thrombosis, 9th ed Guidelines and it includes a consensus approach to managing upper limb DVTs.  Matt Hoffman’s PulmCCM.org site summarises it beautifully here.

Here is an algorithm that I’ve put together as a result of Matt’s summary:

[/su_tab]
[su_tab title=”References”]

 

Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines online

PulmCCM.org summary of the Acute Deep Venous Thrombosis (DVT) of the Arm ACCP Guidelines, 9th Ed.

Treatment of upper-extremity deep vein thrombosis. Rathbun SW, Stoner JA, Whitsett TL. J Thromb Haemost. 2011 Oct;9(10):1924-30.

Upper limb DVT on Ultrasound #1: Sonocloud – Dr. Mike Stone

Upper limb DVT on Ultrasound #2: Sonocloud – Dr. Mike Stone

[/su_tab]
[/su_tabs]

 

Share this
ICN Podcasts hit 40K downloadsThe Canberra ICU course Nov 2012
IPSN – Intensivist Parent Support Network WIN – Women in Intensive Care Network ICN UK ICN NZ ICN WA ICN VIC ICN NSW ICN QLD The ICN Story The Team Jellybean Podcasts ICN Blog SMACC Video SMACC Audio Video ECG Simulator by aclsmedicaltraining BASIC SCIENCE CLINIC Simulation Game Changing Evidence ICU Radiology Echo Guide ECHO Cases Clinical Cases EXAMHELP Jellybean Podcasts ICN Blog SMACC Video SMACC Audio Video CICM Fellowship ANZCA FELLOWSHIP PAEDS FELLOWSHIP EMERGENCY PRIMARY ANAESTHETICS PRIMARY End-o-bed-o-gram

  • About
    •  What is ICN
    •  The Team
    •  ICN NSW
    •  ICN QLD
    •  ICN VIC
    •  ICN WA
    •  ICN NZ
    •  ICN UK
  • Resources
    •  Lung US
    •  Exam Help
    •  Clinical Cases
    •  Echo Cases
    •  Echo Guide
    •  ICU Radiology
    •  Game Changing Evidence
    •  ICN Metafeed
    •  Simulation Resouces
  • Media
    •  SMACC Posters
    •  Audio
    •  Video
    •  Pecha Kuchas
  • Upskill
    •  Clinical Cases
    •  Echo Cases
    •  ICU Radiology
  • Exam Help
    •  End-o-Bed-o-Gram
    •  ICU Primary Exam
    •  CICM Fellowship
    •  ANZCA Fellowship
    •  Paeds Fellowship
    •  Emergency Primary
    •  Anaesthetics Primary

® 2021 The Intensive Care Network || All rights reserved || Disclaimer || Site Map || Contact ICN Support

Log in with your credentials

or     Create an account

Lost your password?

Forgot your details?

I remember my details

Create Account