CICU/CCU Pathway for Management of Acute Catheter-Related Venous Thromboembolism (VTE)
Assess if Catheter is Medically Necessary
Consult Cardiac Thrombosis and
Anticoagulation team
Consult Cardiac Thrombosis and
Anticoagulation team
- Indications for Thrombophilia Evaluation
- Extremity Precautions
- Document thrombus on problem list
- Assess Risk of Bleeding
- Laboratory Evaluation
- Clinical Evaluation
- Recent Surgery
Catheter Remains in Place
Repeat US at 1 week to evaluate for extension
Repeat US at 1 week to evaluate for extension
Active or High Risk of Bleeding
Repeat US at 1 week if anticoagulation is not initiated
Repeat US at 1 week if anticoagulation is not initiated
Risk benefit ratio favors anticoagulation
Consider anticoagulation prior to removal for lesions at high risk for embolization with potential hemodynamic compromise
Remove Catheter
Initiate Enoxaparin
Low Risk of Bleeding
Repeat US in 6 weeks
Clot Resolved
Clot Stable
Clot Progression
Continue enoxaparin and Repeat US at 12 weeks
If clot resolved or stable at 12 weeks
If clot resolved or stable at 12 weeks
Discuss with Cardiac Thrombosis Team
Low Risk
High Risk
- Discontinue enoxaparin
- Discuss use of enoxaparin w/ future indwelling lines
- Discuss with Cardiac Thrombosis Team
- Consider chronic anticoagulation
- Consider enoxaparin while indwelling catheter in place
Therapeutic anticoagulation with future mid and central line
Posted: April 2014
Revised: June 2022
Authors: L. Raffini, MD; T. Giglia, MD; W. Petrosa, CRNP; R. Keashen, CRNP
Revised: June 2022
Authors: L. Raffini, MD; T. Giglia, MD; W. Petrosa, CRNP; R. Keashen, CRNP
Evidence
- Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease
- Antithrombotic Therapy in Neonates and Children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
- Bleeding and Thrombotic Emergencies in Pediatric Cardiac Intensive Care : Unchecked Balances
- Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Anticoagulation and Thrombolysis