Right atrium thrombosis in patients on hemodialysis

Vascular access has been the Achilles heel of hemodialysis for many years, and placement of temporary subclavian and internal jugular vein catheters has been a daily practice for the nephrologist. Now, concern about central vein stenosis, well described with the use of subclavian catheters in end-stage renal disease (ESRD), has prompted the use of internal jugular vein permanent catheters to avoid this complication, so as not to hinder future arteriovenous grafts. Permanent catheter access is not without its own special problems, and we describe here two patients that developed thrombosis of the right atrium while receiving hemodialysis through a permanent internal jugular catheter.