Central Venous Catheter in Obese Patient May Even Cause Cor Pulmonale

Abstract

Introduction: Sometimes the needless usage of central venous catheter, conflicting with indications, has been witnessed. Unfortunately, incidence of axillary-subclavian venous thrombosis has risen gradually because of increased use of the subclavian vein for central venous access. Furthermore obesity is common among patients with deep vein thrombosis, with a prevalence of 20-25%. Presentation of Case: I am presenting a 35-year old morbidly-obese woman with cor pulmonale resulting from post-catheterization thrombosis of jugular, axillary, subclavian veins, and superior vena cava. Discussion: Obese individuals have higher levels of factor VIII and factor IX. Obesity promotes deep vein thrombosis by inducing plasma viscosity and erythrocyte aggregation as well. Obesity causes, via leptin, increasing activity of coagulation cascade and decreasing fibrinolysis. Also it increases inflammation, oxidative stress and endothelial dysfunction. Obesity together with central venous catheter use may increase the risk for the development of deep vein thrombosis and subsequent cor pulmonale. Conclusion: Requirement of central venous catheter must be reconsidered before introducing, especially in an obese patient.