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An abysmal conundrum associated with a misplaced dialysis catheter
Shruthi Muralidharan1, Arunkumar Asokan1, Nembian Raja Rajan2
1Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India.
The Journal of Vascular Access
|August 4, 2024
Summary
A dialysis catheter migrated, causing a dangerous blood clot and pulmonary embolism in a patient with chronic glomerulonephritis. Prompt treatment involving antibiotics, anticoagulants, and surgery successfully removed the clot and catheter.
Area of Science:
- Nephrology
- Cardiology
- Infectious Diseases
Background:
- Chronic glomerulonephritis necessitates hemodialysis, often via internal jugular catheters.
- Dialysis catheter placement carries risks, including migration and infection.
- Catheter-related atrial thrombus (CRAT) is a serious complication.
Observation:
- A 25-year-old female on hemodialysis presented with fever, catheter dysfunction, hypoxia, and hypotension.
- Chest radiography revealed catheter migration into the inferior vena cava.
- Echocardiography confirmed a large thrombus, indicative of CRAT, and severe cardiac dysfunction.
- CT pulmonary angiography showed pulmonary embolism.
Findings:
- Infection with Methicillin-resistant Staphylococcus aureus (MRSA) was identified.
- The patient experienced severe heart dysfunction and pulmonary embolism secondary to the migrated catheter and thrombus.
- Successful management involved antibiotics, anticoagulants, and surgical removal of the thrombus and catheter.
Implications:
- Improper dialysis catheter placement poses significant risks, including life-threatening complications.
- Early diagnosis and multidisciplinary management are crucial for CRAT and associated conditions.
- This case underscores the importance of vigilant monitoring and prompt intervention in dialysis patients.
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