Upper Extremity Impedance Plethysmography in Patients with Venous Access Devices

Summary

Central venous access devices (VADs) are often associated with thrombotic obstruction of the axillary-subclavian venous system. To explore the accuracy of impedance plethysmography (IPG) in identifying this complication we performed IPG on 35 adult cancer patients before their VADs were placed and approximately 6 weeks later. At the time of the second IPG the patients also underwent contrast venography of the axillary-subclavian system. The venograms revealed partial venous obstruction in 12 patients (34%) and complete obstruction in two (5.7%). Although the IPG results from venographically normal and abnormal patients overlapped extensively, mean measurements of venous outflow were significantly lower in the patient population with abnormal venograms (P = 0.052 for V_o; P = 0.0036 for V_o/V_c). In our hands, therefore, upper extremity IPG cannot be used to make clinical decisions about individual patients with VADs, but it can distinguish venographically normal and abnormal populations.

• References

• 1 Mueller BU, Skelton J, Callender DPE, Marshall D, Gress J, Longo D, Norton J, Rubin M, Venzon D, Pizzo PA. A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients. J Clin Oncol 1992; 10: 1943-1948
• 2 Bern MM, Lokich JJ, Wallach SR, Bothe A, Benotti PN, Arkin CF, Grecok FA, Huberman M, Moore C. Very low doses of warfarin can prevent thrombosis in central venous catheters. Ann Intern Med 1990; 112: 423-428
• 3 Haire WD, Lynch TG, Lund GB, Lieberman RP, Edney JA. Limitations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis. J Vase Surg 1991; 13: 391-397
• 4 Haire WD, Lynch TG, Lieberman RP, Edney JA. Duplex scans before subclavian vein catheterization predict unsuccessful catheter placement. Arch Surg 1992; 127: 229-230
• 5 Gray B, Williams LR, Flanigan DP, Schwartz JA, Schuler JJ, Curless D, Socha E. Upper extremity deep venous thrombosis: diagnosis by Doppler ultrasound and impedance plethysmography. Bruit 1983; 7: 30-34
• 6 Patwardhan NA, Anderson FA, Cutler BS, Wheeler HB. Noninvasive detection of axillary and subclavian venous thrombosis by impedance plethysmography. J Cardiovasc Surg 1983; 24: 250-255
• 7 Knight MTN, Dawson R. Effect of intermittent compression on the arms of deep venous thrombosis in the legs. Lancet 1976; ii: 1265-1267