Upper Extremity DVT with subclavians/piccs

I placed a subclavian in a patient with pylephlebitis, put the dude on hepatin and coumadin. All is well. A week later he complains of UE pain and swelling in ipsilateral arm (pt refused IJ). Got U/S and kablamo: clot running from basilic through subclavian. We pulled the line slllooowwwwllllyyyy (he needed placement with long term iv abx so he eventually got an IJ tunnelled picc). we had to heparinize the guy for his portal/superior mesenteric vein clot. How often do you guys see them? How often do you you sweat pulling the line? should you pull the line if its around a picc in a pt who needs long term IV access? If theres a line and a clot and pt bacteremic do you have to pull it (source if bacteremia NOT line) And finally, if no severe sequelae of clot (pain, gross swelling, ischemia) do you anticoagulate? my final thought for this post: had a pt with picc, recovered pna, started having fevers, usual icu w/u neg for source. Attending said "i bet this guy had subclavian clot." bam! there it was.
Source: Student Doctor Network Forums - Category: Universities & Medical Training Authors: Tags: Critical Care Source Type: forums