Solicitado Doppler de Carótidas e Vertebrais para paciente idosa admitida com síndrome neurológica aguda. Aterosclrose discreta do bulbo esquerdo. de achado adicional...
E aí? Retira?Mantém? Anticoagula? Observa?
(Obs: esse cateter foi passado em veia subclávia esquerda e migrou para a jugular)
Retira e anticoagula! Depois repete o Doppler.
ResponderExcluirApós retirada da fonte trombogênica,vc ainda anticoagularia?
ResponderExcluir"Thrombotic Complications -
ResponderExcluirPatients who require central venous catheterization are at high risk for catheter-related thrombosis. Used routinely, ultrasonography with color Doppler imaging detects venous thrombosis in 33 percent of patients in medical intensive care units34 and in approximately 15 percent of these patients the thrombosis is catheter-related. The risk of catheter-related thrombosis varies according to the site of insertion. In one trial, catheter-related thrombosis occurred in 21.5 percent of the patients with femoral venous catheters and in 1.9 percent of those with subclavian venous catheters (P<0.001).5 In an observational study, the risk of thrombosis associated with internal jugular insertion was approximately four times the risk associated with subclavian insertion.28 Subclavian venous catheterization carries the lowest risk of catheter-related thrombosis. The clinical importance of catheter-related thrombosis remains undefined, although all thromboses have the potential to embolize."
Preventing Complications of Central Venous Catheterization
David C. McGee, M.D., and Michael K. Gould, M.D.
N Engl J Med 2003; 348:1123-1133March 20, 2003
Sim, a retirada da fonte emboligênica evitará a formação de novos trombos, eu anticoagularia esta paciente. O grande problema aí seria o tempo de anticoagulação! (que dados temos na literatura???). Acredito que o seguimento com o Doppler possa ter alguma serventia nesta situação.
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