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Significance of Echocardiographically Detected Central Venous Catheter Tip-Associated Thrombi

Jeffrey Forris Beecham Chick1, Shilpa N Reddy2, Ruchika D Bhatt3

  • 1From the Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.

Journal of Vascular and Interventional Radiology : JVIR
|September 24, 2016
PubMed

Insights

Central venous catheter tip thrombi detected on echocardiography appear benign. In patients without intracardiac shunts, no complications occurred, suggesting interventions may be unnecessary.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Medical Imaging

Background:

  • Central venous catheters (CVCs) are frequently used in clinical practice.
  • Thrombi associated with CVC tips can be incidentally detected on echocardiography.
  • The clinical significance and management of these thrombi are not well-defined.

Purpose of the Study:

  • To investigate the significance, management strategies, and clinical outcomes of CVC tip-associated thrombi.
  • To determine the incidence of embolic complications in patients with incidentally detected CVC tip thrombi.

Main Methods:

  • Retrospective review of echocardiogram data from 170 patients with CVCs.
  • Analysis of 49 patients with CVC tip-associated thrombi.
  • Assessment of thrombus size, ejection fraction, intracardiac shunts (including patent foramen ovale - PFO), and management decisions.
  • Follow-up for embolic events (pulmonary embolism, stroke) within 3 months.

Main Results:

  • Mean thrombus size was 2.1 cm.
  • No embolic complications (pulmonary embolism, stroke) were observed in patients without intracardiac shunts.
  • One patient with a PFO and right-to-left shunt experienced a stroke before PFO closure, but not from the CVC thrombus.
  • Management varied, including anticoagulation, catheter removal, or no intervention, with no significant difference in outcomes.

Conclusions:

  • CVC tip-associated thrombi in patients without intracardiac shunts appear to have a benign clinical course.
  • Interventions such as anticoagulation, catheter removal, thrombectomy, or thrombolysis may not be necessary for incidentally detected CVC tip thrombi.
  • Further research is warranted to confirm these findings in larger cohorts.
Abstract

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