“Peripherally inserted central catheter-associated deep vein thrombosis in the upper limbs may present with swelling and venous distension, but most thrombi are asymptomatic [4]. This is likely due to collateral venous drainage provided via veins in the peri-scapular and peri-vertebral areas (Fig. 1a). Therefore, we suggest periodic PICC line monitoring using duplex ultrasound imaging in patients at risk of catheter-related thrombosis.

When a catheter-related thrombus is confirmed but the PICC line is still required and functional, anticoagulation therapy can be initiated with the catheter in place and continued until the thrombus has resolved. In the cases of suspected infection or catheter malfunction, the catheter should be removed following between three and five days of treatment dose heparin, with at least six weeks of systemic anticoagulation thereafter [4].

Takechi K, Shimizu I. Peripherally inserted central catheter line-related deep venous thrombosis. Anaesth Rep. 2022 Mar 7;10(1):e12146. doi: 10.1002/anr3.12146. PMID: 35281515; PMCID: PMC8899903.