Abstract
Objective
To report five patients on hemodialysis via an indwelling central venous catheter who developed a thrombus located exclusively on the right atrial wall opposing the emptying site of the superior vena cava and to determine the possible cause of this location.
Design
Transthoracic echocardiography was performed in four of the patients as work-up for suspected endocarditis or pulmonary embolism and in one patient for syncope evaluation. The right atrial clots were confirmed in all the patients by transesophageal echocardiography.
Design and setting
General intensive care unit of a university hospital, tertiary referral center.
Patients
Five patients with end-stage chronic renal failure on hemodialysis via subclavian or internal jugular vein catheter.
Interventions
Three of these patients underwent surgical thrombectomy, and two others were medically treated.
Measurements and results
The clots were 2–4 cm in length and three of them were infected. Two of the three surgically treated patients and one of the two medically treated patients died. All the patients had the catheter tip in the right atrium, in two of them the bent catheter rubbed the atrial endocardium, and in all the cases the clot was located on the atrial free wall facing the superior vena cava emptying.
Conclusions
We postulate that the mechanism of thrombus formation at this location is related to friction of the catheter on the atrial endocardium, and therefore positioning the distal segment of the central venous catheters in the right atrium should be avoided.
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References
Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, Rigaud JP, Casciani D, Misset B, Bosquet C, Outin H, Brun-Buisson C, Nitenberg G, French Catheter Study Group in Intensive Care (2001) Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 286:700–707
Timsit JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, Carlet J (1988) Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest 114:207–213
Gilon D, Schechter D, Rein AJ, Gimmon Z, Or R, Rozenman Y, Slavin S, Gotsman MS, Nagler A (1998) Right atrial thrombi are related to indwelling central venous catheter position: insights into time course and possible mechanism of formation. Am Heart J 135:457–462
Murphy PT, Sivakumaran M, Ghosh K, Chapman CS, Wood JK (1994) Non fatal massive right atrial thrombosis associated with Hickman catheter in an adult receiving chemotherapy for acute leukemia. Postgrad Med J 70:520–521
Fuchs S, Pollak A, Gilon D (1999) Central venous catheter mechanical irritation of the right atrial free wall: a cause for thrombosis formation. Cardiology 91:169–172
Hollingsed MJ, Morales JM, Roughneen PT, Burch KD (1997) Surgical management of catheter tip thrombus: surgical therapy for right atrial thrombus and fungal endocarditis (Candida tropicalis) complicating paediatric sickle-cell disease. Perfusion 12:197–201
Kentos A, Dufaye P, Jacobs F, De Smet JM, Serruys E, Thys JP (1995) Candida albicans septic thrombosis of the right atrium is associated with a central venous catheter. Clin Infect Dis 21:440–442
Spotnitz WD, Dent JM, Mintz PD, Erickson NL, Fechner RE, Groh MA (1994) Removal of an infected right atrial mass in a patient with sickle cell disease. Ann Thorac Surg 58:1762–1764
Tamary H, Goshen J, Carmi D, Yaniv I, Kaplinsky C, Cohen IJ, Zaizov R (1994) Long-term intravenous deferoxamine treatment for noncompliant transfusion-dependent beta-thalassemia patients. Isr J Med Sci 30:658–664
Horner SM, Bell JA, Swanton RH (1993) Infected right atrial thrombus-an important but rare complication of central venous lines. Eur Heart J 14:138–140
Korzets A, Katz S, Chagnac A, Katz M, Gafter U, Zevin D, Levi J (1994) An infected right atrial thrombus—a new complication of haemodialysis associated subclavian vein catheterisation. Nephrol Dial Transplant 9:1652–1654
Kinney EL, Allen RP, Weidner WA, Pierce WS, Leaman DM, Zelis RF (1979) Recurrent pulmonary emboli secondary to right atrial thrombus around a permanent pacing catheter: a case report and review of the literature. Pacing Clin Electrophysiol 2:196–202
Jolly N, Kaul UA, Khalilullah M (1991) Right atrial thrombus over eustachian valve-successful lysis with streptokinase. Int J Cardiol 30:354–356
Joshi P, Bullingham A, Soni N (1991) Septic atrial thrombus. A complication of central venous catheterisation. Anaesthesia 46:1030–1032
Borges AC, Reibis RK, Claus M, Baumann G (2001) Right atrial thrombus treated successfully with abciximab and heparin. J Thromb Thrombolysis 12:283–287
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Ghani, M.K., Boccalandro, F., Denktas, A.E. et al. Right atrial thrombus formation associated with central venous catheters utilization in hemodialysis patients. Intensive Care Med 29, 1829–1832 (2003). https://doi.org/10.1007/s00134-003-1907-8
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DOI: https://doi.org/10.1007/s00134-003-1907-8