Journal of Thrombosis and Thrombolysis

, Volume 44, Issue 4, pp 427–434 | Cite as

Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio

  • Timothy R. SpencerEmail author
  • Keegan J. Mahoney


In vascular access practices, the internal vessel size is considered important, and a catheter to vessel ratio (CVR) is recommended to assist clinicians in selecting the most appropriate-sized device for the vessel. In 2016, new practice recommendations stated that the CVR can increase from 33 to 45% of the vessels diameter. There has been evidence on larger diameter catheters and increased thrombosis risk in recent literature, while insufficient information established on what relationship to vessel size is appropriate for any intra-vascular device. Earlier references to clinical standards and guidelines did not clearly address vessel size in relation to the area consumed or external catheter diameter. The aim of this manuscript is to present catheter-related thrombosis evidence and develop a standardized process of ultrasound-guided vessel assessment, integrating CVR, Virchow’s triad phenomenon and vessel health and preservation strategies, empowering an evidence-based approach to device placement. Through review, calculation and assessment on the areas of the 33 and 45% rule, a preliminary clinical tool was developed to assist clinicians make cognizant decisions when placing intravascular devices relating to target vessel size, focusing on potential reduction in catheter-related thrombosis. Increasing the understanding and utilization of CVRs will lead to a safer, more consistent approach to device placement, with potential thrombosis reduction strategies. The future of evidence-based data relies on the clinician to capture accurate vessel measurements and device-related outcomes. This will lead to a more dependable data pool, driving the relationship of catheter-related thrombosis and vascular assessment.


Venous thrombosis Catheter to vein ratio Vessel measurement Ultrasound Patient Assessment Outcomes Standardization 



This study did not apply for or receive any type of funding.

Author contributions

TRS and KJM were the primary authors responsible for literature search, review, generation and editing of all versions of the manuscript. Both authors designed and created the Catheter Vessel Ratio Tool discussed in this manuscript. Both authors read and approved the final manuscript before submission.

Compliance with ethical standards

Conflict of interest

Timothy Spencer has received consultancy fees and speaker honorarium from Teleflex Inc. and Ethicon. Timothy Spencer is Presidential Advisor to the Australian Vascular Access Society (AVAS). Keegan Mahoney has received consultancy fees and speaker honorarium from Teleflex Inc.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was not required for the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Global Vascular AccessScottsdaleUSA
  2. 2.Banner Gateway/MD Anderson Cancer CenterPhoenixUSA

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