[Intravenous thrombus detected during central venous catheterization under ultrasonic guidance]

A bedridden 88-year-old woman with cerebral infarction was scheduled for central venous catheterization through the right internal jugular vein under ultrasonic guidance. She had received central venous catheterization through the right internal jugular vein one month before, but the catheter had been removed nine days previously because of catheter infection. The right internal jugular vein was punctured under ultrasonic guidance, but blood regurgitation was not observed. Further observation with ultrasonography showed a high-echoic region in the internal jugular vein, and no blood flow was observed at the vein by Doppler ultrasound examination. In addition, the vein was not compressed by the probe of the ultrasonic device. Intravenous thrombus was suspected, and the procedure was stopped. Risk factors for intravenous thrombus include advanced age, cerebral infarction, bedridden patient, and catheter-related infection. When attempting recatheterization through the same vein for patients with these risk factors, especially catheter-related infection, attention should be paid to the possibility of intravenous thrombus. In cases in which intravenous thrombus is suspected, catheterization should be attempted through another vein.