Atrial thrombus and central venous dialysis catheters

Area of Science:

• Nephrology
• Cardiology
• Vascular Surgery

Background:

• Native arteriovenous fistulas are preferred for hemodialysis access.
• Tunneled central venous catheters are used as an alternative, but complications like thrombosis can occur.
• Right atrial thrombus (RAT) is a known complication of central venous cannulation, particularly in pediatric patients receiving parenteral nutrition or chemotherapy.

Observation:

• This study reports five cases of RAT in patients undergoing long-term hemodialysis with tunneled catheters between 1994 and 1998.
• Diagnosis was often made during investigations for hemoptysis or dyspnea; one case was found via screening echocardiogram.
• Catheter tips were located in the right atrium in four of five cases and in four of nine previously reported cases.

Findings:

• Three of the five patients experienced pulmonary emboli.
• A fourth patient suffered an unexplained cardiac arrest.
• Anticoagulated patients with RAT remain at risk of pulmonary embolism, and atrial thrombectomy was successful in one case.

Implications:

• Placement of central venous catheter tips in the right atrium, while potentially improving dialysis, may increase the risk of RAT.
• This finding suggests a need to reconsider optimal catheter tip positioning to mitigate the risk of right atrial thrombus formation.
• Further research is warranted to establish safer guidelines for central venous catheter placement in hemodialysis patients to prevent serious complications like RAT and pulmonary embolism.