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Mural thrombi in children: potentially lethal complication of central venous hyperalimentation

C E Bagwell1, M B Marchildon

  • 1Department of Surgery, University of Florida College of Medicine, Gainsville.

Critical Care Medicine
|March 1, 1989
PubMed

Insights

Total parenteral nutrition (TPN) can cause dangerous mural thrombi. Echocardiography can diagnose these clots, and thrombolytic agents often treat them effectively, but new venous access methods are needed.

Area of Science:

  • Cardiology
  • Pediatric Medicine
  • Critical Care Medicine

Background:

  • Total parenteral nutrition (TPN) is vital for surgical patients but carries risks.
  • Mural thrombi in central venous catheters are a serious complication.
  • Two pediatric deaths highlight the severity of this risk.

Observation:

  • Echocardiography is accurate and accessible for diagnosing mural thrombi.
  • Routine echocardiographic surveillance is recommended for TPN patients with fever or Candida bloodstream infections.
  • Thrombolytic agents are effective in treating most mural thrombi.

Findings:

  • Mural thrombi associated with TPN can be lethal.
  • Early diagnosis via echocardiography is crucial.
  • Thrombolytic therapy is a viable treatment option.

Implications:

  • Implementing routine echocardiographic surveillance can prevent TPN-related deaths.
  • Further research into novel long-term venous access devices is necessary.
  • This approach can improve patient safety in surgical and critical care settings.

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