Bacterial endocarditis associated with a skin-tunnelled catheter

Skin-tunnelled catheters have become an accepted method for establishing long-term central venous access in patients undergoing treatment for malignancies. They allow administration of continuous infusions of cytotoxic drugs, supplementation of fluids and blood products, total parenteral nutrition and access for the checking of blood tests. It is recognized that there are certain complications associated with their use including the risk of infection both of the exit site and tunnel, as a source of septicaemia, line-associated thrombosis (despite the use of prophylactic low dose warfarin and flushing of the line with heparin) and accidental dislodgement of the line. We report a case of bacterial endocarditis affecting the pulmonary valve shortly after removal of a skin-tunnelled catheter due to line-associated brachiocephalic venous thrombosis.