Abstract
To the Editor.— The report by Chakravarthy et al1inJAMAdescribes an interesting cardiac complication of chronic central venous access but misses the true lesson of the case, the prevention and treatment of catheter-related thrombosis and infection. Fever and evidence for central venous thrombosis were present for months prior to the terminal hospitalization of the patient. It is therefore not surprising that advanced venous thrombosis with extension to the tricuspid valve was found. The authors fail to discuss the diagnosis of the underlying problem, catheter-related septic central venous thrombosis. The diagnosis of catheter-related septic central venous thrombosis is predicated on symptoms and signs of systemic sepsis, blood cultures that continue to be positive even after catheter removal, and central venous thrombosis, best confirmed by venography.2The syndrome is probably underdiagnosed in the seriously ill population at risk with prolonged catheterization, and no more than 50 well-documented cases
Published Version
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