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Central venous catheters are used to provide fluids and chemotherapy for cancer patients. Catheters can become obstructed by clots that form within the catheter lumen; often these are dissolved by instilling small amounts of thrombolytic agents into the catheter. Occlusion also can occur if a fibrin sheath forms around the catheter orifice; mechanical removal of the sheath relieves the obstruction. However, a more complex problem occurs when veins distal to the catheter become blocked, which results in swelling of the arm, neck, or face, depending on the thrombus site. This situation requires systemic anticoagulation, but whether the catheter should be removed as well is unclear.
Investigators in Canada studied 74 patients with active malign…