Right Atrial Thrombus and Challenges in its Management

Right atrial thrombi is a serious complication of central venous cannulation although incidence is less as compared to left atrial thrombi.1 Right atrial thrombi develops at anastomotic foci or on injured endothelium, implanted devices or foreign bodies including tumours, pacemakers and indwelling right atrial catheters. They have been associated with triple-lumen catheters for chemotherapy, intravenous fluids or parenteral nutrition, pulmonary artery catheters, hemodialysis and implantable venous access devices.2 Right atrial thrombi can have severe consequences leading to pulmonary embolism, septic emboli, mechanical problems of cardiac function or even systemic embolization in case of atrial septal defect or patent foramen ovale. Incident rates of CVC-related thrombosis reported in the literature are inconsistent and vary according to host factors, catheter characteristics, cannulation site and the infusates administered. Thrombi within cardiac chambers are associated with an increased risk of mortality due to their propensity for embolization to the pulmonary vasculature.