980-90 Superior Vena Cava Versus Right Atrium Central Venous Catheter Placement Avoids Thrombosis: The Role of Transesophageal Echocardiography in Diagnosis and Evaluation — A Prospective Study

Abstract

Intravenous central line (Hickman type) catheters (CL) are routinely used in the management of chronically ill patients. These CLs are placed in the superior vena cava (SVC) or right atrium (RA) and are often associated with complications, mainly thrombosis or infection. The introduction of transesophageal echo (TEE) has significantly improved the imaging of intracardiac structures, especially left atrial thrombi and right atrial masses. We explored the use and importance of TEE (and compared to transthoracic echo (ITTE)) for early evaluation of CL placement and detection of related masses. We prospectively studied fifty-five (55) bone marrow transplantation (BMT) patients by TTE and TEE at an asymptomatic stage within a week post-Hickman catheter (CL) implantation and on a follow-up study after 6–8 weeks. We looked for the exact CL tip placement and searched for possible presence of any related abnormalities. Of the fifty-five patients in the first study, the CL tips could be demonstrated in 48 (87%) of them by TEE compared to only 4 (8%) by TTE. 13 were placed in the right atrium (RA), 8 at he superior vena cave-right atrium junction (SVC-RA), and 27 in the s superior vena-cava (SVC). An abnormal mass was found in six patients (12.5%) . All of these presumed thrombi were seen in patients in whom the CL tip was placed in the RA (Table) No. of Patients CL location Thrombi 27 SVC 0 8 SVC-RA 0 13 RA 6 (p < 0.001 TEE studies performed in an asymptomatic setting of BMT patients within a week post-routine CL implantation demonstrated unexpected, asymptomatic catheter-tip related masses, consistent with thrombosis, in the RA of 12.5% of patients . These findings suggest that: (1) CL should be placed in the SVC or SVC-RA junction, in contrast to the RA. (2) TEE is a useful tool for guiding CL’s placement in severely immunocompromised, chronically ill patients, to avoid formation of thrombi.