Right Atrial Thrombi Complicating Use of Central Venous Catheters in Hemodialysis

Abstract:: Right atrial thrombus can originate from distal venous sources or can be iatrogenic secondary to placement of central venous catheters, atrial devices, or surgeries. One of the most common complications of central venous catheters (CVCs) is thromboembolism, which can be either fixed to the right atrium or can be free-floating. Device-related right atrial thrombosis (RAT) can result in catheter occlusion, vascular occlusion, infection, and pulmonary embolism. The true incidence of these complications is unknown because the diagnosis may not be considered in asymptomatic patients and might be missed by transthoracic echocardiography (TTE). In this literature review, we discuss iatrogenic etiologies of RAT that is complicated by pulmonary embolism. We highlight the importance of maintaining a high index of suspicion of iatrogenic RAT, possible complications, and its management.

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Is the removal of a central venous catheter always necessary in the context of catheter-related right atrial thrombosis?

The Journal of Vascular Access ◽

10.1177/1129729818774438 ◽

2018 ◽

Vol 20 (1) ◽

pp. 98-101 ◽

Cited By ~ 2

Author(s):

Luigi Rossi ◽

Pasquale Libutti ◽

Francesco Casucci ◽

Piero Lisi ◽

Annalisa Teutonico ◽

...

Keyword(s):

Central Venous Catheter ◽

Combination Therapy ◽

Anticoagulation Therapy ◽

Vena Cava ◽

Young Patients ◽

Venous Catheter ◽

Central Venous Catheters ◽

Right Atrial ◽

Central Venous ◽

Atrial Thrombosis

Catheter-related right atrial thrombosis is a severe and life-threatening complication of central venous catheters in both adult and young patients. Catheter-related right atrial thrombosis can occur with any type of central venous catheters, utilized either for hemodialysis or infusion. Up to 30% of patients with central venous catheter are estimated to be affected by catheter-related right atrial thrombosis; however, neither precise epidemiological data nor guidelines regarding medical or surgical treatment are available. This complication seems to be closely associated with positioning of the catheter tip in the atrium, whereas it is unlikely with a tip located within superior vena cava. Herein, we report the case of a patient affected by catheter-related right atrial thrombosis, who showed a quick resolution of thrombosis with a new therapeutic scheme combining loco-regional thrombolytic therapy (urokinase as a locking solution) and systemic anticoagulation therapy (vitamin K antagonists), thus avoiding catheter removal. Neither complications of the combination therapy were reported, nor recurrence of catheter-related right atrial thrombosis occurred. In conclusion, the combination therapy here described was safe, quick and effective, achieving the goal of not removing the catheter.

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Right atrial electrocardiography: A technique for the placement of central venous catheters for chemotherapy or intravenous nutrition

British Journal of Surgery ◽

10.1002/bjs.1800820545 ◽

1995 ◽

Vol 82 (5) ◽

pp. 715-716 ◽

Cited By ~ 1

Author(s):

N. Williams ◽

M. Madan ◽

M. V. Shah ◽

D. J. Alexander ◽

C. Taylor ◽

...

Keyword(s):

Central Venous Catheters ◽

Right Atrial ◽

Central Venous ◽

Intravenous Nutrition

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Right atrial thrombus in patients with hemodialysis central venous catheters

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2012.01.021 ◽

2012 ◽

Vol 13 (2) ◽

pp. e6-e7

Author(s):

Mushabab Al Murayeh ◽

Adel Al Masswary ◽

Mohamed Moselhy ◽

Khalid Al Sheikh ◽

Ali Y. Moustafa

Keyword(s):

Central Venous Catheters ◽

Right Atrial ◽

Central Venous ◽

Atrial Thrombus ◽

Right Atrial Thrombus

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Infected right atrial thrombi: a complication of central venous cannulation

International Journal of Cardiology ◽

10.1016/0167-5273(94)90100-7 ◽

1994 ◽

Vol 43 (1) ◽

pp. 101-104 ◽

Cited By ~ 3

Author(s):

I.R. Arnold ◽

M.J. Brack ◽

P.K. Verma ◽

A. McCance

Keyword(s):

Right Atrial ◽

Venous Cannulation ◽

Central Venous Cannulation ◽

Central Venous ◽

Atrial Thrombi

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Right Atrial Thrombus Formation Screening Using Two-Dimensional Echocardiograms in Neonates With Central Venous Catheters

PEDIATRICS ◽

10.1542/peds.81.2.284 ◽

1988 ◽

Vol 81 (2) ◽

pp. 284-286

Author(s):

David Marsh ◽

Shirley A. Wilkerson ◽

Larry N. Cook ◽

John B. Pietsch

Keyword(s):

Gastrointestinal Disease ◽

Thrombus Formation ◽

Case Reports ◽

Central Venous Catheters ◽

Right Atrial ◽

Two Dimensional ◽

Central Venous ◽

Atrial Thrombus ◽

Right Atrial Thrombus ◽

Larger Sample

Two-dimensional echocardiograms were used to prospectively screen 49 patients with 56 central venous catheters for right atrial thromboses from October 1985 to May 1986. All but four patients received a two-dimensional echocardiogram prior to insertion of the catheter. Once the catheters were in place, two-dimensional echocardiograms were performed no later than 3 weeks after insertion and then every 14 days until the catheter was removed. A single thrombus was detected 79 days after catheter placement (an incidence of 1.8%). Previous recommendations for weekly screening with two-dimensional echocardiogram were based on case reports alone. The 95% confidence limits for a negative two-dimensional echocardiogram result suggest that the initial two-dimensional echocardiogram screen for thrombus be obtained no sooner than 3 weeks after catheter insertion. In addition, significant gastrointestinal disease requiring operative intervention was present in 10 of 11 previous case reports as well as in our patient. Further studies with larger sample sizes are needed to determine whether subgroups of infants exist who are at a relatively higher risk for right atrial thrombus formation.

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