Catheter-related Atrial Thrombus Research Articles

An abysmal conundrum associated with a misplaced dialysis catheter.

A 25-year-old female patient with chronic glomerulonephritis, initiated on haemodialysis presented with high-grade fever, a dysfunctional catheter, low oxygen saturation and unstable blood pressure. Upon evaluation, the patient was febrile with elevated white blood cell counts. She was intubated, started on inotropes and transferred to the intensive care unit. Chest radiography showed that the tunnelled internal jugular dialysis catheter had migrated to the inferior vena cava. Echocardiography and transoesophageal echocardiography showed severe heart dysfunction with a large thrombus attached to the catheter, indicating catheter-related atrial thrombus (CRAT). CT pulmonary angiography revealed blockage of the segmental pulmonary arteries, suggesting pulmonary embolism. Blood and tracheal cultures revealed Methicillin-resistant Staphylococcus aureus (MRSA). The patient was administered appropriate antibiotics and anticoagulants and underwent surgical removal of the thrombus and the catheter. This case demonstrates the risks associated with improper placement of dialysis catheters and highlights the brief management of CRAT.

Perm-Cath catheter-related atrial thrombus – Case series and management recommendations

Catheter-related atrial thrombus (CRAT) is frequent, with no clear guidelines available with regard to diagnosis and management. Here, we report five patients with Perm Cath related AT. We conclude and recommend that Perm Cath, when not needed or used needs to be removed as soon as possible. A majority of CRAT are detected incidentally. They commonly occur at inferior vena cava and right atrial junction and a transoesophageal echocardiogram is needed in most patients to clearly define the thrombus and see additional hidden thrombi. Differentiating CRAT versus vegetation is difficult and one needs to treat both if blood cultures are positive. Commonly these thrombi do not embolize and are fixed to atrial walls, but silent pulmonary embolism needs to be considered. All patients initially should be treated with intravenous or subcutaneous anticoagulation. Patients with “High Risk” features such as, “multiple thrombi > 2,” “mobile thrombi,” “extending or embolizing thrombi to pulmonary artery,” “infected thrombi,” and “failed anticoagulation” must be considered for thrombolysis followed by surgery if required.

Catheter-related atrial thrombus: tip of the iceberg?

Although guidelines recommend catheters as a last resort for establishing a vascular access in patients undergoing dialysis, they continue to be used widely for this purpose. Catheter-related atrial thrombus (CRAT) is rarely reported in this group of patients, and it can lead to serious complications. The aim of this study was to determine the incidence of CRAT in patients undergoing hemodialysis with permanent-tunneled catheters. A total of 50 patients undergoing hemodialysis with permanent catheters were included in this study. The diagnosis of CRAT was based on transthoracic echocardiography findings. Thrombus was present in nine patients (18%) and related to the tip of the catheter in all cases. Except for one patient with two foci of thrombus, all patients had a single focus. There were no significant associations between the development of thrombus and the duration of catheter use or the location of the catheter. Furthermore, catheter-related atrial thrombus did not appear to have a significant effect on mortality. The asymptomatic character of CRAT can be responsible for the low reporting rates, and its exact role in increased mortality and morbidity related with catheter use remains unknown. While planning management strategies, information on different options for vascular access routes and possible catheter-related complications should be provided to all patients who will undergo dialysis, together with a discussion involving other replacement alternatives for end-stage renal disease.

Catheter-Related Atrial Thrombus Resolved After Catheter Removal in a Patient on Hemodialysis

Catheter-Related Atrial Thrombus Resolved After Catheter Removal in a Patient on Hemodialysis

A Case of Catheter-related Thrombosis Treated with Local Low-dose Urokinase

Although indwelling central venous catheters guarantee a reliable vascular access, and are essential for the management of children undergoing anticancer chemotherapy or stem cell transplantation, these catheters may cause serious mechanical, infectious and thrombotic complications. Central venous catheter-related thrombosis is one of the most important complications that may interfere with the course of treatment. A number of regimens utilizing urokinase have been used but the optimum management of this common problem remains undetermined. We report an 8 year-old boy, who had catheter-related atrial thrombus treated successfully with urokinase. A short course treatment with the use of low-dose urokinase was feasible for the thrombolysis of catheter-related right atrial thrombus in this boy diagnosed with neuroblastoma and undergoing high-dose chemotherapy with autologous peripheral blood stem cell rescue. This treatment was not associated with bleeding. (Korean J Hematol 2006;41:220-224.)