Can a peripheral intravenous (IV) line be placed in an arm with a deep vein thrombosis (DVT)?

Peripheral IV Placement in an Arm with DVT

Peripheral IV placement in an arm with a deep vein thrombosis (DVT) should be avoided due to increased risk of thrombus propagation, embolization, and potential complications. 1

Risks of IV Placement in an Arm with DVT

• Upper extremity DVT accounts for approximately 10% of all diagnosed DVTs, with indwelling venous devices being the highest risk factor for hand/upper extremity DVT 1
• Placing an IV in an arm with DVT may:
  • Disrupt the existing thrombus, potentially causing embolization 1
  • Further damage the vessel wall, promoting thrombus extension 2
  • Impair venous return in an already compromised limb 1
  • Increase risk of post-thrombotic syndrome 2

Alternative Approaches

• Use the contralateral arm (without DVT) for peripheral IV access 2
• If both arms have DVT or peripheral access is impossible:
  • Consider central venous access via a different route (internal jugular or femoral) 2
  • For short-term access needs, femoral catheters can be used for up to 5 days in bed-bound patients with good exit-site care 2
  • For longer-term needs, tunneled cuffed catheters are associated with lower infection rates and higher blood flow rates 2

Important Considerations for Venous Access in Patients with DVT

• Ultrasound-guided cannulation minimizes insertion complications and should be used when available 2
• Subclavian vein catheterization should be avoided due to high risk of central venous stenosis 2
• When placing any venous access device, use the smallest gauge catheter possible to minimize thrombosis risk 2, 3
• Larger catheter size is significantly associated with increased DVT risk 3
• Peripheral ports are associated with significantly higher incidence of DVT compared to chest ports (11.4% vs 4.8%) 4

Management of Patients with DVT

• Anticoagulation is the mainstay of treatment for upper extremity DVT 1
• For catheter-associated DVT, anticoagulation should continue for at least 3 months or as long as the catheter remains in place 1
• Early ambulation is suggested over initial bed rest for patients with DVT of the leg 2
• In patients with acute DVT of the leg or PE, IVC filters should not be used in addition to anticoagulants 2

Clinical Implications and Monitoring

• Patients with upper extremity DVT typically present with ipsilateral upper extremity edema, pain, paresthesia, and functional impairment 1
• Recurrent VTE occurs in 5.1-9.8% of patients with upper extremity DVT 1
• The presence of an intravenous device increases the risk of pulmonary embolism and recurrent upper extremity DVT 5
• Monitor for signs of pulmonary embolism, which occurs in approximately 4.8% of patients with upper extremity DVT 5

By avoiding IV placement in an arm with DVT and following evidence-based approaches to venous access, clinicians can minimize complications and optimize patient outcomes.