sau đó gỡ bỏ, có huyết khối đi? Khi thở máy được thay thế bằng cách thở tự nhiên, intrathoracic áp lực đột nhiên trở nên tiêu cực. Điều gì sẽ xảy ra một huyết khối cho đến bây giờ đã rất flimsily gắn vào tường? | Subclavian Venous Thrombosis 75 then removed where has the thrombosis gone When mechanical ventilation is replaced by spontaneous breathing intrathoracic pressure suddenly becomes negative what happens to a thrombosis that until now had been very flimsily attached to the wall when thrombosis is generated by a catheter near the skin . when there is free communication between skin bacteria and the circulatory system should such thromboses be systematically considered infected In consequence migration of such thrombi may bring the bacteria up to the lungs resulting in positive lung samples. All these issues will be hard to prove. A large study supported by a particularly open ethical committee and comparing the mortality of a group of patients with systematic full-dose heparin the classic treatment for all venous thromboses with a untreated group could reach conclusions on the most adapted management. In practice and according to the precaution principle we avoid the internal jugular approach and insert only subclavian catheters with ultrasound guidance since the subclavian route is reputed to be less exposed to infections. Prolonged observation may show a better outcome for these patients. If a septic thrombophlebitis is suspected ultrasound-guided aspiration of the thrombus with bacteriological analysis can be envisaged at the internal jugular level 7 . Right or wrong we have not investigated this particular situation to date. Subclavian Vein Normal Pattern The discussion in the previous section should theoretically render this vein more attractive. The subclavian vein is localized in a longitudinal subclavian approach visible on the transverse scan of the subclavian vessels. The vein differs from the artery Fig. in many details like the internal jugular vein it does not have a perfectly round section nor perfectly parallel walls but wide movements possible inspiratory collapse. Valves can be observed here. An echoic flow with visible echoic particles is .
