Right atrial thrombus formation associated with central venous catheters utilization in hemodialysis patients.
OBJECTIVE
To report five patients on hemodialysis via an indwelling central venous catheter who developed a thrombus located exclusively on the right atrial wall opposing the emptying site of the superior vena cava and to determine the possible cause of this location.


METHODS
Transthoracic echocardiography was performed in four of the patients as work-up for suspected endocarditis or pulmonary embolism and in one patient for syncope evaluation. The right atrial clots were confirmed in all the patients by transesophageal echocardiography.


METHODS
General intensive care unit of a university hospital, tertiary referral center.


METHODS
Five patients with end-stage chronic renal failure on hemodialysis via subclavian or internal jugular vein catheter.


METHODS
Three of these patients underwent surgical thrombectomy, and two others were medically treated.


RESULTS
The clots were 2-4 cm in length and three of them were infected. Two of the three surgically treated patients and one of the two medically treated patients died. All the patients had the catheter tip in the right atrium, in two of them the bent catheter rubbed the atrial endocardium, and in all the cases the clot was located on the atrial free wall facing the superior vena cava emptying.


CONCLUSIONS
We postulate that the mechanism of thrombus formation at this location is related to friction of the catheter on the atrial endocardium, and therefore positioning the distal segment of the central venous catheters in the right atrium should be avoided.
Ghani
Mohammad K
MK
Medical School, University of Texas-Houston, Houston, Tex., USA.
Boccalandro
Fernando
F
Denktas
Ali E
AE
Barasch
Eddy
E
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013927:Thrombosis / Q000209:etiology*