scholarly journals Right Atrial Thrombus Associated with Central Venous Catheter after Surgical Repair of Co-arctation of Aorta

2021 ◽  
Vol 18 (2) ◽  
pp. 69-71
Author(s):  
Smriti Mahaju Bajracharya ◽  
Sandeep Sapkota
Keyword(s):  
Young Patients ◽  
Venous Catheter ◽  
Right Atrial ◽  
Coarctation Of Aorta ◽  
First Line ◽  
Central Venous ◽  
First Line Therapy ◽  
Venous Catheterization ◽  
Life Threatening ◽  
Atrial Thrombosis

Central venous catheterization (CVC) is a routine and essential procedure performed in patients undergoing cardiac surgery. However, its use is not without complications ranging from mechanical to infectious to thrombotic in nature. Catheter-related right atrial thrombosis (CRAT) is usually underreported as it is commonly small in size and asymptomatic. Nevertheless, CRAT might lead to a potentially severe and life threatening complication in both adult and young patients. Up to 30% of patients with CVCs are estimated to be affected by CRAT.  Anticoagulation and subsequently catheter removal were recommended as a first-line therapy and have suggested that no intervention may be associated with a high mortality rate. Here, we report a case of a 3-months-old male child who underwent coarctation of aorta repair and was diagnosed with right atrial thrombosis associated with CVC in postoperative period and anticoagulated with unfractionated heparin. The thrombus was followed up closely and when there was no further decrease in the size of the mass around 9 days after the diagnosis, the CVC was removed. The heparin was continued even after removal of CVC for further 7 days and patient was eventually discharged from the hospital.

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

2018 ◽  
Vol 20 (1) ◽  
pp. 98-101 ◽  
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.

Catheter-related right atrial thrombosis

2019 ◽  
Vol 21 (3) ◽  
pp. 300-307 ◽  
Author(s):  
Minh-Ha Tran ◽  
Tanya Wilcox ◽  
Phu N Tran
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Primary Treatment ◽  
Hemodialysis Patients ◽  
Right Atrial ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
Catheter Dysfunction ◽  
Surgical Thrombectomy ◽  
Atrial Thrombosis

Introduction: Catheter-related right atrial thrombosis is an under-recognized complication of central venous catheter placement. We performed a retrospective review, characterizing clinical aspects of catheter-related right atrial thrombosis (CRAT). Methods: To identify cases, a literature search was conducted in PubMed and additional items selected by review of related items and bibliography review. Key clinical data were extracted and analyzed both in total and as stratified by hemodialysis versus non-hemodialysis groups. Results: A total of 68 catheter-related right atrial thrombosis events were reported in 63 patients (five recurrences, of which 4 involved catheter left in place following primary treatment). Median (interquartile range) time to CRAT diagnosis was longer among hemodialysis patients – 12 (4.0–24.0) weeks compared to 5.5 (1.8–16.1) weeks among non-hemodialysis patients. The most common presentations were asymptomatic in 16/68 (23.5%), fever/sepsis in 21/68 (30.9%), pulmonary embolism in 11/68 (16.2%), catheter dysfunction in 8/68 (11.8%), dyspnea in 8/68 (11.8%), and new murmur or valvular dysfunction in 8/68 (11.8%) patients. Primary treatment selection was anticoagulation in 33/68 (48.5%), surgical thrombectomy in 17/68 (25.0%), thrombolysis in 12/68 (17.6%), or no active therapy in 6/68 (8.8%) patients. Primary treatment failure for anticoagulation and thrombolysis was 27.3% and 33.3%, respectively. The most common rescue therapy was surgical thrombectomy, ultimately resulting in an overall rate of 26/62 (41.9%). Overall, per-patient mortality was 13/63 (20.6%). Intracardiac tip position – 27/34 (79.4%) – overshadowed thrombophilia – 16/63 (25.4%) – as a risk factor for CRAT. Conclusion: Catheter-related right atrial thrombosis is an underdiagnosed complication of central venous catheter placement. For the hemodialysis population, a fistula-first approach is advocated. While many instances were asymptomatic, the development of unexplained fever, dyspnea, catheter dysfunction, or new murmur should trigger a search for this complication.

scholarly journals Right Atrial Thrombosis Provoked by Central Venous Catheter: A Case Report

Cureus ◽  
2020 ◽  
Author(s):  
Kalyan Prudhvi ◽  
Kris Kumar ◽  
Jayasree Jonnadula ◽  
Rajesh Janardhanan
Keyword(s):  
Case Report ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Right Atrial ◽  
Central Venous ◽  
Atrial Thrombosis

scholarly journals A Formation of a true knot in subclavian venous catheter in a patient in the intensive care unit

2020 ◽  
Vol 24 (6) ◽  
Author(s):  
Dmytro Anatoliovich Shkurupii ◽  
Dmytro Anatoliovich Kholod
Keyword(s):  
Venous Catheter ◽  
Mechanical Complication ◽  
Central Venous ◽  
Physical Force ◽  
Critical Care Units ◽  
Venous Catheterization ◽  
Purulent Peritonitis ◽  
Life Threatening ◽  
Vascular Catheters ◽  
The Right

Vascular catheters installation is most frequently used in critical care units. A node in the catheter lumen is a rare mechanical complication of the central venous catheterization. The 14-year-old was treated for acute appendicitis complicated by diffuse purulent peritonitis. It was decided to install a central venous catheter on the very first day of treatment. A catheterization of the right subclavian vein according to Seldinger was carried out. The catheter functioned properly for 6 days. On the 7th day, in the process of removal of the catheter, its extraction was blocked at a 1 cm depth from the tip. The catheter was removed by strong physical force with the occurrence of a hematoma in the area of installation of the catheter. Once removed, on the catheter there was found a node, formed inside the vessel. In this case, no disabling and life-threatening complications as a result of the use of the catheter were recorded. In the future, the patient was discharged recovered.

Nosocomial Infection and Multidrug-Resistant Bacteria Surveillance in Intensive Care Units: A Survey in France

2005 ◽  
Vol 26 (1) ◽  
pp. 13-20 ◽  
Author(s):  
François L'Hériteau ◽  
Corinne Alberti ◽  
Yves Cohen ◽  
Gilles Troché ◽  
Pierre Moine ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Multiple Correspondence Analysis ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Central Venous ◽  
Venous Catheterization ◽  
Structural Variables ◽  
Tract Infections

AbstractObjectives:To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.Design:A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.Participants:Three hundred ninety-five responder ICUs (69%) in France.Results:In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.Conclusion:This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.

Advanced Surface System for Central Venous Catheter Insertion Training

2020 ◽  
Author(s):  
Dailen Brown ◽  
Haroula Tzamaras ◽  
Jessica M. Gonzalez-Vargas ◽  
Scarlett Miller ◽  
Jason Moore
Keyword(s):  
Sensor Array ◽  
Low Cost ◽  
Venous Catheter ◽  
Maximum Deviation ◽  
Central Venous ◽  
Insertion Depth ◽  
Hall Effect Sensor ◽  
Cost System ◽  
Venous Catheterization ◽  
Measured Position

Abstract An advanced surface for Central Venous Catheterization (CVC) training and evaluation was designed using sensorization techniques, including the use of a hall effect sensor array to measure the insertion depth of a catheter. The sensor array was tested for accuracy in both static and dynamic scenarios, and was found to be sufficiently accurate; measuring position with an accuracy of ±1.1 mm on average. The highest deviations in measured positions were located at the extreme ends of the array where calculations rely on only a single sensor. The maximum deviation in measured position was found to be 3.5 mm. This low-cost system of catheter measurement has the potential to improve feedback and assessment of CVC training.

Increase in Use of Vancomycin for Clostridium difficile Infection in US Hospitals

2010 ◽  
Vol 31 (8) ◽  
pp. 867-868 ◽  
Author(s):  
Amy L. Pakyz ◽  
Norman V. Carroll ◽  
Spencer E. Harpe ◽  
Michael Oinonen ◽  
Ronald E. Polk
Keyword(s):  
Clostridium Difficile ◽  
Primary Treatment ◽  
Epidemic Strain ◽  
First Line ◽  
Oral Vancomycin ◽  
Treatment Practices ◽  
First Line Therapy ◽  
Life Threatening ◽  
Vancomycin Resistant ◽  
Serious Disease

Clostridium difficile infection (CDI) is a potentially serious disease for which the epidemiology has recently changed, because of an emerging drug-resistant strain of the pathogen. Metronidazole and oral vancomycin are the primary treatment agents.2 Metronidazole has been historically favored as the first-line agent, partly to reduce the selection pressure for vancomycin-resistant enterococci (VRE), although metronidazole can also select for VRE. Vancomycin was traditionally reserved for metronidazole treatment failure or life-threatening disease. In a study conducted before emergence of the epidemic strain, vancomycin was reported to be superior for the initial treatment of severe CDI and for treatment of CDI that does not respond to metronidazole. Expert opinion calling for the use of vancomycin as first-line therapy, especially for severe CDI emergence of the epidemic strain, and reports of decreased metronidazole efficacy may have impacted CDI treatment practices. The purpose of this study was to characterize trends in CDI treatment in US hospitals.

scholarly journals Optimal position of a long-term central venous catheter tip in a pediatric patient with congenital diseases

2012 ◽  
Vol 4 (3) ◽  
pp. 32 ◽  
Author(s):  
Marco Caruselli ◽  
Dario Galante ◽  
Anna Ficcadenti ◽  
Laura Carboni ◽  
Federica Franco ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
High Frequency ◽  
Young Patients ◽  
Venous Catheter ◽  
Central Venous ◽  
Optimal Position ◽  
Congenital Diseases ◽  
The Past ◽  
Catheter Tip

Progress in medical and scientific research has increased the chances of survival for young patients with congenital diseases, children who, in the past, would not have had any chance of survival. Nowadays, congenital diseases can be treated with appropriate replacement therapies. These treatments can be difficult to administer in young patients because of the high frequency of administration (sometimes more than a dose per week), the use of intravenous infusion and the long-term or life-term requirement.

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