# Catheter-related thrombosis in people with cancer: diagnosis, anticoagulation and whether the line can stay

Source: https://onco.cc/protocols/catheter-related-thrombosis-in-cancer/  
OnCo record `catheter-related-thrombosis-in-cancer` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A blood clot can form around a central line, such as a port or a PICC. Signs include a swollen, painful or red arm, neck or face, swollen veins on the chest, or a line that will not flush or give blood. An ultrasound scan confirms it. It is treated with blood thinners for at least three months, and the line can often stay in if it still works and is not infected.

## Summary

Symptomatic catheter-related thrombosis (CRT) is reported in about 4 to 8% of people with cancer and lines (ESMO 2015), and many more clots are found on screening. Signs are often non-specific; the first is often difficulty aspirating or infusing, with local pain, redness, swelling or oedema. Doppler ultrasound is the usual first test [III, A]; venography or other imaging follows when ultrasound is normal but suspicion remains or central occlusion is suspected [III, A].

ITAC (2022, guidance) recommends anticoagulation for at least 3 months and for as long as the catheter is in place, suggesting LMWH, and notes that LMWH, DOACs and VKAs have not been compared directly in CRT. The catheter can stay if it is functional, well positioned and not infected, with symptoms resolving under close surveillance. ESMO (2015) adds that where the line is no longer needed or long-term anticoagulation is contraindicated, 3 to 5 days of anticoagulation before removal is recommended [I, A], and that the line should come out if symptoms progress or the clot extends into the superior vena cava. Routine anticoagulant prophylaxis against CRT is not recommended (ITAC 1A); right-sided jugular insertion with the tip at the cavoatrial junction is (1B), and ITAC suggests ports over PICCs where a central line is needed (guidance).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: CRT; line clot; PICC clot; port thrombosis; upper extremity DVT from a line; central line thrombosis; catheter-associated thrombosis

## Connected records

- protocols: [Anticoagulation for a blood clot in a person with cancer: choice of drug, duration and special situations](https://onco.cc/protocols/cancer-associated-vte-treatment/), [Blocked central line or port: assessment and clearing with a thrombolytic](https://onco.cc/protocols/central-line-occlusion-management/), [Central line and port removal: when, how and what to watch for afterwards](https://onco.cc/protocols/central-line-removal/), [Central venous catheter insertion for anticancer treatment: PICC, tunnelled line and implanted port](https://onco.cc/protocols/central-venous-catheter-insertion-for-anticancer-therapy/), [Choosing a venous access device for anticancer treatment: port, PICC, tunnelled line or cannula](https://onco.cc/protocols/venous-access-device-selection-for-anticancer-therapy/), [Implanted port access, flushing and care in adults having cancer treatment](https://onco.cc/protocols/implanted-port-access-and-care/), [PICC and tunnelled central line care: dressing, hub cleaning, flushing and living with the line](https://onco.cc/protocols/picc-and-tunnelled-line-care/), [Suspected central line infection in a person with cancer: paired blood cultures, first antibiotics and line removal or salvage](https://onco.cc/protocols/suspected-central-line-infection/)
- technologies: [Cancer-associated thrombosis prevention and treatment](https://onco.cc/technologies/cancer-associated-thrombosis/), [Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)](https://onco.cc/technologies/implanted-ports/), [Peripherally inserted central catheters (PICC lines)](https://onco.cc/technologies/picc-lines/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/), [Venous thromboembolism (VTE)](https://onco.cc/terms/vte/)

---
JSON: https://onco.cc/api/v1/entities/catheter-related-thrombosis-in-cancer.json